DrCareMSO is a Medical Management Services Organization founded in 2018, providing revenue cycle management, medical billing, credentialing, and consulting services to healthcare practices of all sizes. Headquartered in FL-Tarpon Springs, USA, we serve providers across the United States through HIPAA-compliant remote operations.
Medical Billing & RCM Questions Answered
Per DrCare MSO's analysis of 500+ provider accounts managed since 2018, practices that outsource RCM see an average 18-point improvement in net collection rate within the first 90 days.
74+Questions Answered
8Topic Categories
7+Years Experience
500+Providers Served
General
· 10 questionsDrCareMSO was founded in 2018 and has spent over 7 years managing revenue cycles for 500+ providers across 30+ medical specialties. That operating history gives our team deep, pattern-recognition expertise that newer vendors simply cannot replicate.
We serve over 30 medical specialties including cardiology, orthopedics, gastroenterology, dermatology, neurology, oncology, urology, OB/GYN, radiology, urgent care, and behavioral health. Visit our Specialties page for the full list — if your specialty is not listed, contact us directly.
Yes. We serve practices of all sizes — from solo practitioners seeing 80 patients per week to large multi-specialty groups and hospital systems processing millions in monthly claims. Our engagement model scales to match your volume, complexity, and budget without any minimum size requirement.
DrCareMSO is headquartered in FL-Tarpon Springs, USA. We serve healthcare providers nationwide through secure, HIPAA-compliant remote access to your existing systems — no relocation, no hardware, no disruption to your current workflow.
Three things set us apart: (1) specialty-specific billing teams — your account is not managed by generalists; (2) real-time transparency through live dashboards you access 24/7; and (3) a percentage-based fee model that aligns our incentives entirely with your collections. We win only when you win.
Yes. We offer a complimentary initial consultation with no obligation. During that call, our team reviews your current billing performance, identifies gaps, and provides a projection of what optimized RCM could recover for your practice. Most practices discover 8–15% in overlooked revenue during the first session.
Getting started takes three steps: (1) schedule a consultation via our Contact page; (2) our team conducts a current-state assessment of your billing and AR; (3) we define a custom onboarding plan and go live within 2–3 weeks. No long implementation cycles, no switching software.
An MSO is an entity that provides non-clinical administrative and management services to physician practices and healthcare organizations. These services include billing, credentialing, compliance, HR, and technology — freeing clinicians to focus on patient care while a professional management team runs the business side.
Yes. We provide references from current clients in your specialty upon request during the consultation process. Our 97% client retention rate reflects consistent, measurable results — we are confident in every reference we share.
Medical Billing
· 12 questionsMost practices see measurable improvements within the first 60–90 days, including a reduction in denial rate and faster payment cycles. Significant revenue increases — typically 8–18 points in net collection rate — materialize within the first 6 months as systematic corrections compound.
We maintain a 98.5% clean claims rate on first submission — substantially above what most in-house teams achieve.MGMA 2023: industry average clean claim rate = 83%
Yes. Our denial management team analyzes root causes, files appeals within 48 hours of denial receipt, and implements upstream process changes to prevent recurrence. We achieve an 85% appeal overturn rate — well above the industry norm of 45–55%.
Absolutely. We currently manage billing for hospital systems processing over $2 million in monthly claims at 97%+ accuracy. Our team structure scales horizontally — additional volume is absorbed without service degradation or account-manager churn.
Yes. Our team includes certified experts in Medicare Part A/B and Medicaid billing across multiple states, with deep knowledge of regulatory requirements, LCD/NCD compliance, and timely filing rules for each program.
We submit claims electronically within 24 hours of receiving complete documentation, with a 98% first-pass acceptance rate through clearinghouse. Faster submission directly compresses your days-in-AR and accelerates cash flow.
Yes. We generate professional patient statements, set up payment plans, and manage patient-responsibility collections with a tone that protects your patient relationships. Our patient-balance recovery rate averages 72%, compared to a typical in-house rate of 45–55%.
A clean claim is one submitted with all required data fields complete and accurate, passing clearinghouse edits and payer validation on the first attempt. Clean claims are paid faster — typically 14–21 days vs. 45–90 days for dirty claims — and generate zero rework cost. Every percentage point improvement in clean claim rate directly accelerates cash flow.
Upcoding is billing a higher-level E&M or procedure code than the documentation supports, which constitutes fraud under federal law. We prevent it through dual-layer audits: our coders verify medical necessity against documentation before submission, and our compliance team runs random post-payment audits monthly. Every coder holds an active CPC or CCS certification.
Modifiers append additional clinical information to a CPT code — indicating bilateral procedures, multiple surgeons, reduced services, or assistant surgeons — and directly affect reimbursement amount. Missing or incorrect modifiers cause downcoding, bundling errors, or outright denials. Our coders are trained in modifier logic for each payer and specialty, preventing lost revenue from modifier misuse.
A remittance advice (RA) — also called an Explanation of Benefits (EOB) — is the document payers send after adjudicating a claim, showing payment amounts, adjustments, and denial reason codes. Our team processes every RA within 24 hours, posting payments, identifying systematic denial patterns, and flagging contractual underpayments for immediate follow-up.
Self-pay patients require a different workflow: upfront cost estimates, financial counseling, sliding-scale fee schedules where applicable, and payment plan agreements before or at the time of service. We manage all of these touchpoints, including eligibility checks for charity care programs.HFMA 2023: average self-pay collection rate is 20–25%; our clients average 38%
Revenue Cycle
· 10 questionsOur RCM service covers the entire revenue cycle: patient scheduling support, eligibility verification, prior authorization, charge capture, claim scrubbing and submission, payment posting, denial management, A/R follow-up, and monthly performance reporting. It is a closed-loop system with no handoff gaps.
We provide real-time dashboards and comprehensive monthly reports tracking KPIs including clean claims rate, days in A/R, net collection rate, denial rate by payer and reason code, and revenue trend vs. prior period. You access these dashboards 24/7 — no waiting for a monthly PDF.
Our clients achieve an average 96% net collection ratio, compared to the industry average of 85–90%. That 6–11 point gap represents millions in annual revenue for mid-size practices that previously left it on the table.
Our A/R recovery team uses a systematic aging-bucket approach — 30, 60, 90, 120+ days — with escalating follow-up protocols per bucket. We achieve a 90% recovery rate on collectible accounts, and we distinguish collectible from non-collectible before pursuing, so your team is never chasing phantom AR.
We maintain a 14-day average turnaround from claim submission to payment posting.MGMA 2023: industry average turnaround = 30–45 days; our clients average 14 days
Days in AR varies by specialty, payer mix, and billing efficiency. Tracking your days in AR against specialty benchmarks is one of the first diagnostics we run on every new client account.MGMA 2023: median AR days = 35 for primary care, 45 for specialties, 55+ for surgical subspecialties
Gross collection rate compares payments received to total charges billed — a misleading metric because practices set their own charge amounts. Net collection rate compares payments received to the contractually allowed amount after payer adjustments, making it the true measure of billing efficiency. We track and report only net collection rate.HFMA benchmark: net collection rate above 95% is considered best-in-class performance
Timely filing limits (TFLs) range from 90 days to 1 year depending on the payer. When TFLs are violated, the claim is denied with no appeal pathway — the revenue is permanently lost. We prevent TFL denials through automated submission tracking with hard alerts at 70% of each payer's TFL window, giving the team time to resolve documentation gaps before the deadline.
Coordination of Benefits (COB) claims arise when a patient carries coverage under two or more payers. We identify primary and secondary payer order through eligibility checks, submit to the primary first, and cross-over the claim to the secondary upon receipt of the primary EOB. This prevents balance-billing errors and captures the maximum allowable reimbursement from both payers.
A charge capture audit is a systematic comparison of clinical documentation — visit notes, procedure records, lab orders — against the charges actually billed. The goal is to identify missed charges, duplicate charges, and unbundling errors.AAPC 2022: 5–10% of services rendered go unbilled in practices without regular charge capture audits
Credentialing
· 10 questionsWe average 30 days for most commercial payers. Medicare enrollment takes 45–60 days. We compress these timelines through proactive payer follow-up, complete application preparation on day one, and tracking every open item to resolution — not waiting for payers to contact us.
Yes. We provide full CAQH management including initial profile creation, data entry, document upload, and quarterly attestation — a task many practices miss, causing credentialing lapses that generate denied claims for months before anyone notices.
Yes. We have credentialed providers across all 50 states with both state-specific Medicaid programs and national commercial payer networks including BCBS, Aetna, Cigna, UHC, Humana, and Medicare. Multi-state providers receive a unified tracking dashboard.
We handle all appeals and liaise directly with the payer's credentialing department to identify and resolve the issue. Our thorough application preparation approach — verified against each payer's specific checklist — has resulted in a 100% eventual success rate across all credentialing engagements to date.
Yes. Our automated tracking system monitors every expiration date for every provider: state licenses, DEA registrations, board certifications, NPI revalidations, and malpractice insurance. Renewals are initiated 90 days in advance — well before any payer credentialing committee receives a lapse notification.
Credentialing is the verification of a provider's qualifications — education, training, licensure, and history — conducted by a hospital or payer. Provider enrollment is the administrative process of formally joining a payer's network so that claims can be submitted and paid. Both are required; we manage them as a unified workflow to eliminate gaps between verification approval and first-claim payment.
Most payers require re-credentialing every 2–3 years. We initiate re-credentialing 180 days before expiration, compile updated documentation, and manage the submission and follow-up to completion — preventing the revenue interruption that occurs when providers unknowingly lapse from a network.
A Medicare opt-out is a formal agreement in which a physician elects not to participate in Medicare and agrees not to bill Medicare for any covered services. It is appropriate for direct-pay concierge practices or physicians whose patient population does not include Medicare beneficiaries. We advise on opt-out suitability and manage the affidavit filing process.
The OIG (Office of Inspector General) exclusion list identifies individuals and entities excluded from participation in federal healthcare programs due to fraud, abuse, or criminal convictions. Billing Medicare or Medicaid while employing an excluded individual — even unknowingly — triggers severe civil monetary penalties. We run monthly exclusion checks on every provider and key staff member in our clients' organizations.
Group credentialing enrolls the practice entity (NPI-2) with each payer, while individual credentialing enrolls each rendering provider (NPI-1). Many practices incorrectly bill under a group NPI for providers who are not individually enrolled, generating systematic denials. We manage both levels simultaneously and coordinate the linkage between group and individual NPIs so claims route correctly.
Compliance
· 9 questionsYes. All processes, systems, and team members are fully HIPAA compliant. We conduct annual Security Risk Analyses, enforce minimum-necessary access controls, sign Business Associate Agreements with every client, and maintain an incident response plan — meeting both the Privacy Rule and Security Rule requirements.
Our certified coders (CPC, CCS) follow current CPT, ICD-10, and HCPCS guidelines. We perform prospective coding audits before submission and retrospective audits on random samples monthly. Coders receive mandatory annual training on code set updates released each October by the AMA and CMS.
Yes. We maintain audit-ready documentation at all times and assist with payer audits (RAC, MAC, ZPIC), OIG compliance reviews, and internal audit preparation. Our documentation structure is specifically organized to respond to medical record requests within 24–48 hours.
We implement automated checks against National Coverage Determinations and Local Coverage Determinations before claim submission. When a service does not meet coverage criteria, we generate and obtain Advance Beneficiary Notices (ABNs) before the service is rendered — protecting both the practice from denial and the patient from surprise liability.
The No Surprises Act (effective January 2022) prohibits balance billing for emergency services and certain non-emergency services at in-network facilities by out-of-network providers. It requires Good Faith Estimates for uninsured and self-pay patients. We implement compliant GFE workflows, train staff on the disclosure requirements, and manage the Independent Dispute Resolution process when payer payments fall below contractual thresholds.
We review every claim against the patient's insurance status, the treating facility's network status, and the rendering provider's network participation before submission. For out-of-network scenarios triggering NSA rules, we apply the correct cost-sharing limits and generate the required patient notices.CMS 2023: penalties for NSA violations range up to $10,000 per violation per day
A contractual adjustment is a pre-agreed reduction between a provider and a payer — the difference between your billed charge and the payer's allowed amount under your fee schedule. A write-off is a discretionary decision to forgive a balance without a contractual basis — often a compliance risk if applied inconsistently or used as a routine collection substitute. We enforce strict write-off approval workflows to prevent abusive patterns that attract audit scrutiny.
Best practice is a quarterly internal coding audit and an annual external audit by an independent party. Practices under a Corporate Integrity Agreement with OIG are required to audit more frequently.OIG Compliance Guidance: sample at least 5–10 records per provider per quarter for internal review
The OIG Work Plan is an annual publication listing the specific billing areas and provider types the Office of Inspector General will audit in the coming year. We review the current Work Plan at the start of each year and adjust our internal audit priorities to focus on the same high-risk areas the OIG will scrutinize — proactively identifying vulnerabilities before federal auditors do.
Pricing
· 8 questionsWe offer transparent, percentage-of-collections pricing. Our fee is applied only to funds we actually collect on your behalf — not to billed charges, not to contractual adjustments. This model means our interests are aligned with yours: we maximize collections because our compensation depends on it.
We minimize upfront costs significantly. Most services are offered on a percentage-of-collections basis with no setup fee. For A/R recovery and coverage discovery engagements, we operate on pure contingency — you pay nothing unless we recover revenue.
No. We operate on month-to-month agreements with no long-term lock-in. Our 97% client retention rate reflects the fact that practices stay because results are real and measurable — not because they are contractually obligated.
Our monthly fee includes all billing operations, denial management and appeals, payment posting, patient statement generation, patient collections, monthly KPI reporting, dedicated account manager support, and ongoing performance optimization reviews. No hidden add-ons.
A fee schedule is the list of charges your practice bills for each procedure code. It should be set at 200–250% of Medicare rates for most specialties to preserve negotiation room and avoid leaving money on the table. CMS updates Medicare fee schedules every January — your practice fee schedule should be reviewed and updated simultaneously. We include an annual fee schedule review for all active clients.
ROI on outsourced billing has three components: (1) recovered revenue — additional collections above your current baseline; (2) eliminated costs — staff salaries, benefits, billing software, clearinghouse fees, and training that move off your P&L; (3) opportunity cost — the clinical hours your physicians recover when they stop managing billing problems.DrCare MSO data: average practice recovers 8–12% additional net revenue in year one after transition
Yes. We offer modular service tiers: billing-only, full RCM, RCM plus credentialing, and a complete MSO package including compliance consulting and technology support. This allows practices to start with their most pressing need and expand services as the relationship grows.
There is no minimum engagement period for our standard billing and RCM services — month-to-month from day one. For A/R recovery projects, we ask for 90 days to complete the full aging-bucket analysis and appeal cycle, which is the minimum time needed to show results on older outstanding balances.
Technology
· 9 questionsYes. We integrate with all major EHR and practice management systems including Epic, Cerner, Athenahealth, eClinicalWorks, NextGen, Allscripts, Kareo, DrChrono, Modernizing Medicine, and 20+ more. Our team works inside your existing system — no migration required.
No. We work directly in your existing EHR and practice management system via secure remote access. No migration, no new software to purchase, no staff retraining. Your workflows stay intact — only the billing results change.
We establish HIPAA-compliant VPN tunnels or encrypted remote desktop sessions to your environment. All access is logged, session-recorded, role-based, and governed by our signed Business Associate Agreement. Patient data never leaves your environment — we work inside it remotely.
Yes. We provide 24/7 access to live financial dashboards showing claim status by payer, payment trends, denial rates by reason code, AR aging distribution, and revenue vs. prior period. You see exactly what our team sees — no information asymmetry between client and vendor.
Standard onboarding takes 2–3 weeks: week one for system access setup and workflow documentation; week two for parallel processing (our team shadows your current process); week three for full transition and go-live. Urgent staffing gaps can be covered within 48 hours.
Telehealth billing requires specific place-of-service codes (02 for telehealth away from home, 10 for patient's home), correct GT or 95 modifiers depending on payer, and awareness of each payer's telehealth coverage policies — which continue to evolve post-pandemic. Our team tracks telehealth billing rules across all major payers and updates workflows in real time when CMS or payer policies change.
The modifier requirement depends on payer and service type. For Medicare, modifier 95 indicates synchronous telehealth via interactive audio/video. For Medicaid and commercial payers, modifier GT is commonly used. Audio-only services generally require modifier 93. Place of Service code 02 or 10 is required on virtually all telehealth claims. We apply the correct combination per payer to prevent avoidable denials.
Yes. We support patient portal configurations within compatible EHRs for electronic statement delivery, online payment acceptance, and payment plan management. Electronic statements have a 3× higher open rate than paper statements and a 2× higher payment rate — reducing patient AR days significantly.
We deliver monthly reports in Excel, PDF, and via live dashboard. Standard reports include: collection summary, denial analysis by payer and reason code, AR aging, clean claim rate trend, and revenue by provider and CPT code. Custom reports are available on request at no additional cost.
Prior Authorization
· 7 questionsManual prior authorization takes an average of 2+ business days for routine requests and 5–7 days for complex procedures, creating scheduling delays and patient dissatisfaction.CAQH 2022 Index: electronic prior auth averages 13 minutes vs. 2+ days manually
Prior authorization delays and denials are one of the top three causes of revenue leakage in medical practices. When procedures are delayed or abandoned due to unresolved authorizations, practices lose both the procedure revenue and downstream care revenue.AMA 2023 PA Survey: 94% of physicians report PA delays patient care; 33% report PA caused a serious adverse event
A denied prior authorization does not mean the case is closed. We file a Level 1 appeal within 3 business days with supporting clinical documentation, a physician-written letter of medical necessity, and peer-reviewed literature where applicable. If the Level 1 appeal is denied, we escalate to an expedited Level 2 review. Our PA appeal overturn rate is 71%.
Yes. Prior authorization management is included in our full RCM service. Our team submits PA requests to payers, tracks every open authorization by expiration date, obtains extensions before services lapse, and manages denials through the full appeal process — removing the administrative burden entirely from your clinical staff.
We reduce PA turnaround through three mechanisms: (1) electronic PA submission where the payer supports it, cutting turnaround from days to hours; (2) pre-built clinical documentation templates per payer and procedure type, so the first submission is always complete; and (3) real-time payer portal monitoring so approvals are captured and transmitted to your scheduler the same day — not buried in a fax queue.
High prior-authorization-volume codes span several categories: advanced imaging (MRI 70553, CT 74178), interventional procedures (spinal injections 62323, joint injections 20610), surgical procedures (total knee arthroplasty 27447, lumbar fusion 22630), behavioral health (psychological testing 96130–96131), and high-cost medications billed under a medical benefit. We maintain a payer-specific PA requirement matrix updated monthly across all major payers.
A prior authorization is payer approval for a specific procedure or service, issued before service delivery. A referral authorization is a primary care physician's formal referral of a patient to a specialist — required by HMO and some PPO plans before the specialist visit is covered. Both require separate workflows and tracking systems. We manage both authorization types within a unified platform, preventing claims from slipping through without the correct authorization on file.
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