Medical Billing Services
That Put Revenue Back
Where It Belongs
Charge capture, CPT/ICD-10 coding, denial management, and payment posting — for practices across all 50 states. No software change. No EHR migration.
Average Days in AR
Claim Scrub Protocol
Rejection Rate Reduction
Go-Live Timeline
What Is a Medical Billing Service?
A medical billing service manages claims submission, denial management, and payment collection for medical practices. The service covers CPT/ICD-10 coding through final payment posting, so clinical staff spend time on patients — not payer appeals.
Per HFMA's revenue cycle benchmarking data, in-house billing operations cost 12–14% of collections when salaries, benefits, software, and turnover are factored in. Outsourced billing services like DrCare MSO charge 4–9% — and a 2023 Change Healthcare survey found that 65% of denied claims are never reworked at practices with in-house billing teams under 3 FTEs, simply because there is not enough time.
The 6-Stage Revenue Pipeline
Every claim follows a defined 6-stage process. Nothing is batch-closed, nothing is queued for later — each stage runs on a fixed timeline from charge entry through final payment.
Charge Entry & Coding Review
Every encounter is reviewed by an AAPC-certified CPC before submission — catching E/M upcoding, modifier errors, and diagnosis mismatches before the claim leaves your system.
97-Check Claim Scrubbing
Claims pass a 97-point scrub — not the standard 12 clearinghouse checks — covering modifier conflicts, NPI/taxonomy mismatches, and payer-specific formatting requirements.
Electronic Claim Submission
Claims transmit via ASC X12/EDI 837 through Availity, Waystar, and Change Healthcare. A claim is not logged as 'submitted' until clearinghouse acceptance is confirmed.
Payment Posting & ERA Reconciliation
Every ERA is auto-posted and reconciled against the original claim. Underpayments are flagged for contractual adjustment review before the appeal window closes.
Denial Management
Each denial is categorized by ANSI reason code (CO-4, CO-11, CO-97, CO-16, PR-1, PR-2) and routed to the correct appeal pathway. Written response within 5 business days. No batch-closing of low-dollar denials.
AR Follow-Up
AR over 30, 60, and 90+ days is worked by balance size and payer using payer-specific escalation protocols — not a single follow-up script applied across all carriers.
Payers Are Using AI to Deny Claims. Your Billing Has to Match That.
Physicians across specialties report spending 3–4 unbillable hours per week managing denial appeals alone. Per analysis of CMS data, algorithmic denial rates have climbed more than 30% in targeted claim categories — driven by payer systems built to reject claims before clinical review reaches a human.
According to DrCare MSO's analysis of claims processed across primary care and specialty practices in 2024, practices that matched payer-specific appeal protocols to each ANSI denial code recovered an average of 34% more denied revenue than those using a single-template appeal approach.
Built Different From the Start
Per HFMA's revenue cycle benchmarking data, the average cost to collect for in-house billing operations runs between 12–14% of collections when you account for salaries, benefits, software, training, and turnover. Most outsourced billing services charge 4–9%. The gap widens further when you factor in denial recovery: a 2023 Change Healthcare survey found that 65% of denied claims are never reworked at practices with in-house billing teams under 3 FTEs — because there is simply not enough time.
Per MGMA's 2024 Cost Survey, the industry benchmark for days in AR across primary care practices is 35–40 days. DrCare MSO clients average 28 days — 20% below that benchmark.
What's Included
Every account covers the full revenue cycle — claim submission, denial management, AR follow-up, and reporting in a single structure with no add-on fees.
Charge Entry & Coding Review
Every encounter reviewed by an AAPC-certified CPC (CPC, CPC-H, or specialty equivalent) before submission — catching revenue leaks at the source.
97-Check Claim Scrubbing
Extended 97-point scrub versus the standard 12-point clearinghouse check — covering modifier conflicts, NPI/taxonomy mismatches, and payer-specific formatting rules.
Electronic Claim Submission
Claims transmit via ASC X12/EDI 837 through Availity, Waystar, and Change Healthcare within 24 hours of charge entry — with confirmed clearinghouse acceptance.
Payment Posting & ERA Reconciliation
Every ERA auto-posted and reconciled against the original claim. Underpayments flagged against contracted payer rates before the appeal window expires.
Denial Management
Denials categorized by ANSI reason code (CO-4, CO-11, CO-97, CO-16, PR-1, PR-2) and routed to the correct appeal pathway — written response within 5 business days.
Financial Reporting
Weekly submission summaries, monthly performance reviews covering clean claim rate, denial rate by reason code, days in AR, and open AR aging — in formats your CFO can use.
Specialty-Specific Medical Billing
DrCare MSO covers 22+ specialties. Each specialty page details that specialty's CPT code breakdown, common denial patterns, and payer-specific billing rules.
Key Benefits
Eight reasons practices across 22+ specialties trust DrCare MSO with their revenue cycle.
No Software Lock-In
DrCare MSO works within your existing EHR. If you switch systems in two years, your billing relationship continues without disruption.
Transparent, Published Pricing
Claim submission, denial management, AR follow-up, payment posting, and reporting are covered in a single structure — no surprise charges for working your denials.
AAPC-Certified Coders
Every coder holds an active CPC, CPC-H, COC, or specialty-specific AAPC credential. Certification status is verified annually and available upon request.
Domestic Operations, Direct Access
Coding and denial management teams operate domestically with direct phone and email access during your practice's business hours — not a timezone-delayed ticketing system.
Named Specialist on Your Account
Every practice gets a specific billing specialist and account manager with direct contact information and a guaranteed response time in your service agreement.
28-Day Average AR
DrCare MSO clients average 28 days in AR — 20% below the MGMA benchmark of 35–40 days for primary care practices.
Go Live in 15 Business Days
No EHR migration, no software installation, no gap in your billing cycle. Most practices are transmitting clean claims by day 15.
Free 60-Minute Billing Audit
A billing specialist reviews your denial rate by reason code, AR aging breakdown, and clean claim percentage — whether you work with us afterward or not.
"Our days in AR dropped from 52 to 26 within the first quarter. DrCare MSO found denial patterns our in-house team had missed for two years — and fixed them at the coding level."
Dr. Amanda Foster
Family Medicine · Lakewood Medical Group
"We went from 22% denial rate to under 6% in four months. The difference was having coders who actually knew our specialty — not generalists."
James R., Practice Administrator
Orthopedic Surgery Group — Dallas, TX
Top Denial Reasons by ANSI Code — What They Mean for Your Practice
Every denial DrCare MSO receives is categorized by ANSI reason code before routing to an appeal pathway. The six codes below account for over 70% of all initial denials across the practices we serve.
| ANSI Code | Denial Reason | Root Cause | DrCare MSO Response |
|---|---|---|---|
| CO-4 | Modifier required or invalid | Missing or incorrect CPT modifier | Caught at 97-point scrub; corrected before submission |
| CO-11 | Diagnosis not consistent with procedure | ICD-10 code doesn't support medical necessity | AAPC coder review; medical necessity documentation added |
| CO-97 | Procedure included in another service | Bundling edit triggered | Unbundling analysis; Modifier 59/XE/XU applied where appropriate |
| CO-16 | Lacks information for adjudication | Missing NPI, taxonomy, or auth number | Pre-submission data validation; resubmission within 48 hrs |
| PR-1 | Deductible amount applied | Patient responsibility — deductible not met | Posted correctly; patient balance statement generated |
| PR-2 | Coinsurance amount | Patient co-insurance responsibility | Reconciled against contracted rate; underpayment review completed |
Source: DrCare MSO analysis of claims processed in 2024 across primary care, orthopedic, and behavioral health practices.
Frequently Asked Questions
Answers to the questions practices ask most before switching to outsourced billing.
Explore Related Services
Revenue Cycle Management
End-to-end RCM from patient access through final collections.
Medical Credentialing
Credentialing across Medicare, Medicaid, and 60+ commercial payers.
Denial Management
ANSI-coded denial categorization and written appeals within 5 business days.
AR Recovery Services
Structured AR follow-up for claims over 30, 60, and 90+ days.
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