Applied Behavior Analysis
Behavioral Health
Authorization units, supervision ratios and treatment plan renewals govern nearly every claim.
Payer complexityVery high
Services
The work, described by what actually happens.
Four groups of functions. Each one exists because a specific part of the revenue cycle fails predictably when nobody is accountable for it.
Service groups
Open a group. See the functions and the sequence.
Practices rarely lose money in one place. They lose it in small amounts across charge lag, unposted remits and an AR bucket nobody has time to open.
Medical Billing
Daily claim preparation and submission with edits applied before transmission, not after rejection.
Charge Entry
Charges captured from the note within an agreed turnaround, with missing-encounter reconciliation against the schedule.
Payment Posting
ERA and manual posting at line level, with contractual variance flagged rather than written off.
Accounts Receivable
Aging worked by payer and cause, oldest and highest-value balances first, with documented follow-up on each touch.
Denial Management & Appeals
Root cause identified, correction made, appeal filed with the documentation the payer asked for.
Patient Balances
Statements that explain themselves, and a process for handling patient questions without escalating to the provider.
How the work moves
Charge captureScrub & submitAcknowledgement reconciliationPayment postingDenial triageAR follow-upReporting
How we operate
Four commitments that hold across every engagement.
- 01
We tell you what we found, including the parts that are working
An audit that only finds problems is a sales document. Ours states what your team is doing well so you know where not to spend money.
- 02
Every denial gets a cause, an owner and a date
Resubmission without diagnosis is how the same claim fails twice. Causes are reviewed monthly and the fix goes upstream.
- 03
Queries go to providers in clinical language
A coder asking for 'MDM support' gets ignored. A coder asking which comorbidities were considered gets an answer.
- 04
We do not ask you to change systems
Migration is disruption billed as improvement. We work in your EMR and your clearinghouse.
Engagement rhythm
What the first ninety days look like.
Week 1
Discovery
We review a sample of your claims, your aging, and your denial history. You get a written read on what is actually happening — including the parts that are working.
Weeks 1–2
Onboarding
Access, roles and responsibilities are agreed in writing. We document who owns each handoff between your front desk, your clinicians and our team.
Weeks 2–3
Integration
We work inside your EMR and clearinghouse rather than asking you to change systems. Edits, work queues and posting rules are configured to your payer mix.
Weeks 3–4
Parallel run
New claims move through our process while legacy AR is triaged in parallel, so the transition does not create a cash gap.
Ongoing
Daily operations
Charges, submissions, posting and AR follow-up run on a fixed daily rhythm with a named account contact who knows your practice.
Monthly
Reporting
A monthly review covering collections, aging movement, denial causes and the specific fixes applied. No metric appears without an explanation.
Quarterly
Growth
New providers enrolled, new locations onboarded, and payer performance reviewed against your contracts.
Specialty coverage
Every specialty bills differently. That is the entire job.
Search below for your specialty and read the specific billing problem it creates — the thing a general billing service will miss.
63 specialties
Psychiatry
Behavioral Health
Evaluation and management combined with psychotherapy add-ons requires precise time documentation.
Payer complexityHigh
Psychology
Behavioral Health
Testing and evaluation services frequently need pre-approval and clear medical necessity.
Payer complexityHigh
Mental Health Counseling
Behavioral Health
Plan-specific session limits and telehealth rules change often and quietly.
Payer complexityModerate
Substance Use Treatment
Behavioral Health
Level-of-care documentation and concurrent review drive continued authorization.
Payer complexityVery high
Physical Therapy
Rehabilitation
Timed unit rules, therapy thresholds and recertification windows need active tracking.
Payer complexityHigh
Occupational Therapy
Rehabilitation
Functional goals must connect to each billed intervention or the payer questions necessity.
Payer complexityHigh
Speech-Language Pathology
Rehabilitation
Evaluation versus treatment distinctions and school-adjacent coverage rules complicate claims.
Payer complexityModerate
Chiropractic
Rehabilitation
Maintenance-versus-active-care determinations are the leading denial driver.
Payer complexityHigh
Sports Medicine
Rehabilitation
Mixed office, imaging and procedure billing across multiple sites of service.
Payer complexityModerate
Pain Management
Rehabilitation
Injection procedures with heavy prior authorization and imaging linkage requirements.
Payer complexityVery high
General Surgery
Surgical
Global period tracking and unrelated-visit modifiers determine what is separately payable.
Payer complexityHigh
Orthopedic Surgery
Surgical
Implants, staged procedures and post-operative therapy overlap across payers.
Payer complexityVery high
Plastic & Reconstructive Surgery
Surgical
Cosmetic versus reconstructive determination requires documentation built before submission.
Payer complexityVery high
Otolaryngology (ENT)
Surgical
Office procedures, allergy services and audiology mix professional and technical components.
Payer complexityHigh
Neurosurgery
Surgical
Complex operative reports with co-surgeon and assistant reporting rules.
Payer complexityVery high
Vascular Surgery
Surgical
Diagnostic imaging bundled with intervention creates frequent bundling disputes.
Payer complexityVery high
Bariatric Surgery
Surgical
Long pre-authorization pathways with documented conservative therapy history.
Payer complexityVery high
Ambulatory Surgery Centers
Surgical
Facility and professional split billing with implant and supply reporting.
Payer complexityHigh
Family Medicine
Primary Care
Preventive and problem-oriented visits on the same day need clean modifier handling.
Payer complexityModerate
Internal Medicine
Primary Care
Chronic care and remote monitoring programs carry their own documentation minimums.
Payer complexityModerate
Pediatrics
Primary Care
Immunization administration, well-child schedules and Medicaid variation by state.
Payer complexityModerate
Geriatrics
Primary Care
Annual wellness visits, care management and advance care planning stack carefully.
Payer complexityHigh
Urgent Care
Primary Care
Place-of-service accuracy and payer-specific urgent care contracting.
Payer complexityModerate
Concierge & Direct Care
Primary Care
Hybrid membership and insurance billing requires clear separation of services.
Payer complexityModerate
Cardiology
Medical Specialists
Diagnostic testing with professional and technical splits and strict interpretation requirements.
Payer complexityHigh
Neurology
Medical Specialists
Electrodiagnostic studies and infusion therapy with high pre-authorization volume.
Payer complexityHigh
Gastroenterology
Medical Specialists
Screening versus diagnostic endoscopy changes patient responsibility entirely.
Payer complexityHigh
Rheumatology
Medical Specialists
Biologic infusions require benefit investigation and buy-and-bill reconciliation.
Payer complexityVery high
Endocrinology
Medical Specialists
Diabetes technology, supplies and education services sit across separate benefits.
Payer complexityHigh
Nephrology
Medical Specialists
Dialysis service reporting follows monthly capitated patterns unlike office billing.
Payer complexityVery high
Pulmonology
Medical Specialists
Testing, sleep studies and durable equipment coordination across vendors.
Payer complexityHigh
Infectious Disease
Medical Specialists
Prolonged services, inpatient rounding and antimicrobial therapy oversight.
Payer complexityHigh
Oncology
Medical Specialists
Drug acquisition, waste reporting and regimen authorization on a per-cycle basis.
Payer complexityVery high
Hematology
Medical Specialists
Infusion timing and laboratory linkage must match the treatment record precisely.
Payer complexityVery high
Allergy & Immunology
Medical Specialists
Testing panels and immunotherapy vial preparation billed on separate schedules.
Payer complexityHigh
Dermatology
Medical Specialists
Lesion sizing, pathology linkage and cosmetic exclusions decided at documentation.
Payer complexityHigh
Ophthalmology
Medical Specialists
Eye codes versus evaluation and management, plus imaging frequency limits.
Payer complexityHigh
Optometry
Medical Specialists
Routine vision and medical benefits belong to different payers for the same patient.
Payer complexityModerate
Podiatry
Medical Specialists
Routine foot care exclusions require qualifying systemic condition documentation.
Payer complexityHigh
Radiology
Medical Specialists
Global, professional and technical component reporting by site of service.
Payer complexityHigh
Pathology
Medical Specialists
Specimen-level unit reporting and reference laboratory coordination.
Payer complexityHigh
Anesthesiology
Medical Specialists
Time units, base units and medical direction modifiers govern payment.
Payer complexityVery high
Obstetrics & Gynecology
Women's & Men's Health
Global maternity packages break apart when care transfers mid-pregnancy.
Payer complexityVery high
Maternal-Fetal Medicine
Women's & Men's Health
High-frequency ultrasound with strict medical necessity and frequency editing.
Payer complexityVery high
Fertility & Reproductive Medicine
Women's & Men's Health
Benefit exclusions and lifetime maximums require verification before every cycle.
Payer complexityVery high
Urology
Women's & Men's Health
Office procedures and imaging with device and supply reporting.
Payer complexityHigh
Women's Health
Women's & Men's Health
Preventive service coverage rules differ sharply between commercial and government plans.
Payer complexityModerate
Men's Health
Women's & Men's Health
Coverage often depends on documented diagnosis rather than presenting complaint.
Payer complexityModerate
Home Health
Post-Acute & Home-Based
Episode-based payment with certification and face-to-face documentation requirements.
Payer complexityVery high
Hospice & Palliative Care
Post-Acute & Home-Based
Election periods, level of care and attending physician reporting.
Payer complexityVery high
Skilled Nursing Facilities
Post-Acute & Home-Based
Consolidated billing rules determine what the facility owns versus the provider.
Payer complexityVery high
Durable Medical Equipment
Post-Acute & Home-Based
Written orders, proof of delivery and rental-to-purchase conversion tracking.
Payer complexityHigh
Wound Care
Post-Acute & Home-Based
Debridement depth, graft application and product units drive reimbursement.
Payer complexityVery high
Infusion & Specialty Pharmacy
Post-Acute & Home-Based
Drug pricing, units and waste documented per administration.
Payer complexityVery high
Telehealth Practices
Additional Practice Types
Modifier and place-of-service rules that vary by payer and by state.
Payer complexityHigh
Emergency Medicine
Additional Practice Types
High volume, high acuity, with documentation captured under time pressure.
Payer complexityHigh
Hospitalist Groups
Additional Practice Types
Admission, subsequent care and discharge day reporting across facilities.
Payer complexityHigh
Laboratory Services
Additional Practice Types
Panel bundling, frequency limits and ordering provider documentation.
Payer complexityHigh
Sleep Medicine
Additional Practice Types
Facility and home testing pathways with pre-authorization gates.
Payer complexityHigh
Occupational & Employer Health
Additional Practice Types
Workers' compensation and self-pay employer contracts run parallel to insurance.
Payer complexityHigh
Dietetics & Nutrition
Additional Practice Types
Coverage depends on diagnosis and plan-specific preventive benefit design.
Payer complexityModerate
Audiology
Additional Practice Types
Diagnostic testing covered medically while devices often are not.
Payer complexityModerate
Send us twenty claims.
A sample of recent claims and a current aging report is enough for us to tell you where revenue is leaving. No commitment attached to the answer.