Medical billing and coding that gets claims right the first time
Charge entry, coding review, claim submission and payment posting, done daily inside your practice management system by a team that follows payer rules closely.
Why claims come back
Most rejected and denied claims are not mysteries. They trace back to a short list of causes: a code that doesn't support the diagnosis, a missing or wrong modifier, an expired authorization, a typo in the member ID, a charge that never made it out of the EHR. Each one costs a resubmission at best, and lost revenue at worst when it slips past a payer's filing limit. For traditional Medicare, that limit is generally 12 months from the date of service (42 CFR 424.44), and many commercial payers set shorter ones.
In a busy practice, billing is often one person's side job. When that person is out, charges wait. When they leave, the knowledge of each payer's quirks leaves with them.
What we do
We take over the daily billing core and run it the same way every day, with written procedures for your practice.
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Charge entry and reconciliation
We enter charges from the EHR or superbills and reconcile them against the schedule, so no visit goes unbilled.
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Coding review
We review CPT, HCPCS and ICD-10-CM codes and modifiers against the documentation and payer policy, and send questions back to the provider.
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Claim scrubbing
Every claim is checked against payer rules and NCCI edits before submission.
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Electronic submission
Clean claims go out in daily batches through your clearinghouse.
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Rejection fixes
Clearinghouse and payer front-end rejections are corrected and resubmitted as soon as they show up in the clearinghouse report.
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Payment posting
ERAs and paper EOBs are posted and reconciled, with underpayments and zero-pays flagged.
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Patient balance hand-off
Correct patient responsibility is moved to statements once insurance has paid.
How it works
Billing review
We look at a sample of recent claims, rejections and your fee schedule to see where errors start.
BAA and access
Signed BAA, then named accounts in your EHR, practice management system and clearinghouse.
Procedures in writing
We document your charge workflow, coding rules, payer quirks and who answers which questions.
Daily cycle
Charges entered and reviewed, claims scrubbed and submitted, rejections fixed, payments posted.
Monthly review
A report on claim volume, first-pass acceptance, rejection reasons and open coding questions.
What you get
Daily claim batches submitted on business days, with a log of what went out.
A coding question queue so providers answer in one place, not in hallway conversations.
Rejection log with the reason and fix for each rejected claim, so the same error is not repeated.
Posted, reconciled payments that match your bank deposits.
A monthly billing report in plain English: volumes, acceptance rate, top rejection reasons and what we changed.
Payer notes that capture each payer's rules and stay with your practice.
Who it's for
- Practices where billing is a part-time job for someone with other duties
- Practices whose biller left or is about to retire
- New practices that need billing set up correctly from day one
- Groups that want a second set of eyes on coding before claims go out
Systems we work in
We work in your existing EHR and practice management system and submit through your current clearinghouse, for example athenahealth, eClinicalWorks, Tebra, AdvancedMD, NextGen, DrChrono, ModMed or Practice Fusion, with clearinghouses such as Availity, Office Ally or Waystar. Using something else? Tell us. We learn your setup before we touch a claim.
Product names are trademarks of their owners and are listed to show compatibility, not partnership or endorsement.
Coding questions stay with your providers
Coding is a judgment based on documentation. Our role is to apply the code sets correctly and to ask when the note doesn't support what was billed. We never change clinical documentation and never code to a higher level than the record supports. Questions are logged, answered by the provider and kept for reference.
Pricing
We quote billing and coding after an intro call, based on your claim volume, specialty and how much of the workflow you hand off. You get a written quote before any work starts. Insurance payments always deposit into your practice's bank account.
Medical billing & coding questions
Straight answers. If yours isn't here, email hello@claimcoders.com.
What is the difference between medical billing and medical coding?
Coding translates the visit documentation into standard code sets: CPT and HCPCS for procedures and services, ICD-10-CM for diagnoses. Billing uses those codes to build, submit and follow up on the claim and post the payment. Read our guide on medical billing vs. coding.
Do you code from our documentation or just enter what the provider selects?
Either, depending on your workflow. Many practices have providers select codes and want a second review. Others want us to code from the note. We agree on the approach in writing, and coding questions always go back to the provider. We never change documentation.
Which specialties do you bill for?
We support independent and group practices in primary care and many specialties. Tell us your specialty on the intro call and we will be straight with you about fit and any payer rules we need to learn first.
How often are claims submitted?
We submit clean claims in daily batches on business days, once charges are entered and reviewed. Claims with open questions are held and flagged, not guessed.
Do you handle denials too?
Basic rejections and corrections are part of billing. Full denial management, appeals and A/R follow-up are part of our revenue cycle management service.
Send cleaner claims, starting this month.
Tell us your specialty, volume and practice management system. We reply within one business day.