E/M, modifiers, HCC. Provider-level discipline, not generic queues.
Multi-specialty groups, IPAs, MSOs, and ACOs. We staff specialty-aware coders, run provider-level CDI feedback, and reconcile payer rosters quarterly so revenue doesn’t get stuck behind a credentialing gap.
specialties
Six functions tuned for physician revenue.
Physician billing rewards modifier discipline, E/M defensibility, and provider-level CDI. Below is what we run, and where physician groups usually leak.
E/M leveling & defensibility
2021/2023 E/M guidelines applied with provider-by-provider trending. Under-leveling and over-leveling both flagged. Documentation gaps fed back to the provider, not buried in a query queue.
Surgical bundling & modifier discipline
Modifier 22, 51, 59, 78, 79, 24, 25, 57, 58 nuance handled by surgical-bench coders, not generalists. NCCI-edit posture maintained. Global-period management is a workflow, not a guess.
HCC capture & risk-adjustment
For ACO, MA, and ACA-risk contracts. MEAT-supported documentation, provider-level RAF trending, and v24/v28 model awareness. We tell you which providers under-document. and coach them.
Payer roster reconciliation
Provider enrollment dies quietly. We run a quarterly truth-up against payer directories, payer rosters, and CAQH. Effective dates verified, retro-billing windows captured, gaps escalated before claims hit the floor.
Denial management with provider feedback
Denials are taxonomized to root cause. The top-5 causes feed monthly upstream fixes. in physician practices, that’s usually documentation. Providers see specific examples, not generic queries.
AR follow-up & underpayment recovery
Dollar-weighted aging. Payer-specific cadence. Underpayment audits against fee schedules surface variances quarterly. the dollars most groups don’t know they’re missing.
Where physician groups usually win or lose.
Primary care & internal med
Annual wellness, TCM, CCM, AWV. HCC capture in the routine visit, not just the annual.
Surgery & surgical sub
Modifier discipline, global periods, ASC vs office vs HOPD splits. Multi-surgeon billing.
Cardiology
Cath lab bundling, EP procedures, modifier 51/59, device monitoring follow-up.
Orthopedics
Global period management, hardware coding, DME splits, workers’ comp workflows.
OB/GYN
Global OB packaging, antepartum-only, delivery types, fetal monitoring rules.
Multi-specialty & IPA / ACO
Risk-adjustment governance across many TINs. Provider-level RAF and quality-gate management.
Five phases. Same partner.
Provider audit
10 charts per provider on a stratified sample. Baseline E/M, modifier, and HCC posture locked.
Roster truth-up
Every provider validated against every payer. Effective dates, CAQH, license status. all confirmed.
Cutover
Specialty benches assigned. Edit library loaded. Parallel run on the first cycle.
Provider feedback
First round of provider-level coaching cards. CFO scorecard line by line.
QBR + audit
External coding audit. Senior partner walks the scorecard with practice leadership.
Six SLAs. Physician-specific.
| METRIC | TARGET | WHY IT MATTERS |
|---|---|---|
| Clean-claim rate | 95%+ | Professional clean-claim rate, by payer. Tracked daily, reported monthly. |
| Days in AR (dollar-weighted) | 32-38 | Physician-typical range. Specialty mix adjusted. |
| Denial rate | < 5% | By payer + root cause. Provider-level when documentation is the cause. |
| Coding accuracy | 95%+ | Random monthly sample, externally audited quarterly. |
| RAF capture (where applicable) | +0.05 to 0.15 | Documentation-attributable RAF lift, year over year, per provider. |
| Net collection rate | 96-98% | Cash collected vs. allowable, against payer-contract terms. CFO-audited annually. |
The bench is organized by specialty, not by your TIN.
Most physician-billing vendors stand up a generic team per client. We organize coders by specialty: a surgical bench, a cardiology bench, an OB bench, an HCC bench. The same coder sees enough specialty volume to learn the edge cases. and that’s where the revenue is.
Provider-level depth, not pool-level breadth.
- Specialty-aware coding. modifier discipline, global periods, HCC documentation rigor.
- Provider-level coaching cards. specific examples, not generic policy memos.
- RAF trending per provider. you see who under-documents, you can coach them.
- Quarterly roster truth-up. revenue doesn’t sit behind a credentialing gap.
- Underpayment audit. quarterly variance against contract; dollars recovered.
Four monthly outcomes.
Get a free 25-chart audit.
Send us 25 recent charts. mix of E/M, surgical, and (if applicable) HCC visits. We’ll send back a written accuracy and revenue-leak read. No obligation.