Family Practice Medical Billing Services

Almost always because the administration charge is missing. Every dose has two billable parts: the vaccine product itself and the work of giving it. Practices bill the product, forget the administration, and collect roughly half of what the visit earned. We reconcile your immunisation log against submitted claims every week so no dose goes out with only one line.

The order was likely coded as diagnostic rather than screening. Preventive screening is covered at full benefit only when there is no symptom driving it. Once a complaint is attached, the same test becomes diagnostic and cost sharing applies. The distinction lives in the diagnosis code, which comes from how the physician documented the reason for the order.

Yes, if the sick work is significant and documented separately. Treating an ear infection found during a routine check is billable. Noting that a cough is improving is not. The note needs a distinct section for the problem with its own assessment and plan, and the claim needs the right modifier. Without both, expect the extra line to deny.

Check the plan first, because many exclude them. When excluded, collect from the family at the time of service rather than billing insurance and waiting for a denial. Some plans will cover the exam if it is performed as the patient's annual preventive visit. That only works once a year, so scheduling matters more than coding here.

It supplies vaccines at no cost for eligible children. You do not bill for the product, but you can still bill the administration. Practices new to the program often bill neither and lose the administration revenue entirely, or bill the product by mistake and trigger a recoupment. Eligibility has to be recorded at the visit, not reconstructed later.

Preventive medicine codes are banded by patient age and split by new versus established status. Choosing the adult code for a seventeen-year-old, or the new patient code for someone seen two years ago, produces a clean denial. Our scrubbing checks age and visit history against the code before submission, which removes this category almost completely.

Very much so. Lesion removals, laceration repairs, joint injections, and wart treatments all carry their own value beyond the visit. Family practices frequently document these clinically and never charge for them. The requirement is detail: site, size, method, and closure type where relevant. We flag encounters where a procedure appears in the note but not on the claim.

By establishing the order of responsibility before the claim goes out. The primary plan adjudicates first, then the secondary claim is submitted with that remittance attached. Errors here look like eligibility denials but are really sequencing problems. Children covered by both parents are the common case, and the rule for which plan comes first is not always obvious.

Where the payer recognises it, yes. Some plans allow additional codes for services provided outside normal posted hours or on holidays. Recognition varies considerably, and a few payers ignore these codes entirely. We check each of your contracts rather than adding the codes blindly, since submitting them to payers that reject them just creates rework.

Small family practices often gain the most. You carry the same benefit complexity as a large group but cannot justify a full-time certified coder. Percentage-based pricing scales with your collections instead of charging a flat fee. The things to confirm are a named contact, direct access to your reports, and whether the vendor will work your existing aged claims.