Family Practice Billing Services

E/M and preventive visits, chronic care management, immunizations and annual wellness visits.

Family practice is paid for a great deal it does not bill. A preventive visit and a problem visit on the same day are both payable with modifier 25. Annual wellness visits, chronic care management and transitional care management are all separate services with their own rules. Our family practice billing services look for those encounters instead of waiting for the charge.

The other half is panel size. Being credentialed is not the same as being listed as an available primary care provider. A practice that never filed the PCP panel request can be fully contracted and still have an empty schedule.

Our Services

One of the Busiest Specialties There Is

Family practice is one of the busiest areas in healthcare. You treat injuries, diseases and disorders across a whole family, and each needs the same attention.

More conditions means more complicated billing and coding. We take that complexity off you and make it run smoothly. Our family practice billing services cover the whole cycle, so your revenue improves and your patients stay happy. What was never your job stops being your problem.

What benefits are provided by our Family Practice Management Billing and Coding Services?

  • Flawless Executions

    The more complicated a process is, the more mistakes it produces. That is true everywhere except where the people doing it know the work. We get results because we set the foundations properly at the start, and that shows up later in what gets collected.

  • Successful Approaches:

    A good strategy starts with a clear picture. We look at what your claims have done in the past and match that against how payers behave now. From there we build a plan for each insurer, from the difficult ones to the easy ones.

The visits family practice gets wrong most often

Family medicine bills more distinct service types than almost any other specialty, and the money is lost in the overlaps.

Preventive and problem visits on the same day

A patient comes in for a physical and mentions their blood pressure is up. Two things happened, and both are billable when the note supports it: the preventive visit, and a problem visit with modifier 25. Most practices bill one and give away the other.

The test on review is whether the problem work stands on its own. If you remove every line about the physical and there is still a history, an assessment and a plan for the blood pressure, the second visit was real. If not, it was not.

Well child visits and vaccines

Every vaccine is two charges: the product and the giving of it. Practices routinely bill the product and drop the administration, which is pure loss on every child seen. For patients under nineteen where the vaccine is counselled, there is a separate administration code set, and it is billed per component of the vaccine rather than per injection.

Where the state supplies the vaccine through a federal childhood programme, the product is not charged but the administration still is, in the way that state requires. Getting this wrong across a busy paediatric panel adds up quickly.

Annual wellness visits are not physicals

The Medicare annual wellness visit is a defined set of elements, not a head to toe examination. A practice that performs a physical and bills a wellness visit fails on review. A practice that performs a proper wellness visit and bills it as a problem visit gives away the higher payment.

Work you already do and do not bill

Two services sit unbilled in most family practices. Chronic care management pays monthly for coordination between visits for patients with two or more long term conditions. Transitional care management pays more than a routine follow up when you reach a patient within two business days of discharge and see them in the window. Both are missed for want of a process, not for want of the work.

Family Practice Credentialing and PCP Panel Assignment

For a family practice the credentialing application is the easy part. The step that brings patients is PCP panel assignment: being listed as an available primary care provider so that plan members can be attributed to your panel. It is normally a separate request from the credentialing application, it is frequently never filed, and a fully contracted family physician can sit with an empty schedule because of it.

Practices using NPs and PAs need each mid-level enrolled and linked to the group contract, and should ask whether that mid-level can hold their own panel. Some plans allow it, some require the patients to be attributed to a supervising physician, and the answer changes your capacity.

We file the credentialing, the panel requests and the mid-level linking together. See our medical credentialing services and, for mid-levels, nurse practitioner credentialing.