Primary Care
Front‑to‑back revenue cycle support designed for visit‑heavy primary care.
Common Pain Points We Solve
Eligibility & Benefits
- High no-show rates tied to outdated eligibility checks.
- Chronic issues with referrals, prior auths, and specialist coordination.
- Incorrect PCP assignment causing claim denials.
- Patients unaware of deductibles/copay responsibilities.
Coding Consistency
- Missed CPT II quality codes impacting incentive payouts.
- Inconsistent use of chronic care codes (CCM/TCM, AWV add-ons).
- Incorrect or missing modifiers (e.g., -25, -59) causing preventable denials.
- Visit leveling varies widely by provider and template design.
A/R Backlog
- Preventable denials from eligibility, referrals, and bundling edits.
- AWV, CCM, and TCM claims aging due to documentation gaps.
- Slow patient-pay follow-up, especially for high-deductible plans.
- Underpayment and zero-pay errors missed due to limited audit controls.
What We Do
Revenue Integrity
- CPT II and quality-measure coding reviews to maximize incentive payouts.
- Chronic care management (CCM), annual wellness visits (AWV), and TCM optimization.
- Charge capture audits for missed E/M and preventive care opportunities.
- EMR template redesign to improve documentation and coding accuracy.
Denial Management
- Fix top PCP denials: eligibility, bundling, PCP-assignment, and referral requirements.
- Root-cause reviews focused on reducing repeat errors.
- Claim edits based on payer-specific rules.
- Formal appeals workflow with SLAs and issue tracking.
Patient Pay
- Clear financial policy templates for primary care practices.
- Statement setup and integration.
- Payment workflows to reduce front-desk burden.
How We Drive Results
Quality Program Enablement
- Increased CPT II capture across top quality measures (DM, HTN, depression, preventive care).
- Enhanced care-gap closure rates
- Improved AWV, CCM, and TCM opportunities.
- Better reporting.
Benchmarks We Improve
- First-pass acceptance rate & denial prevention.
- Days in A/R, aging >90 days, and patient-pay collection rate.
- Charge capture completeness, including preventive and chronic care add-ons.
- Provider documentation accuracy & E/M leveling consistency.
- Coding compliance for CPT II, AWV, CCM, TCM, and chronic condition management.
Workflow, EMR, and Process Optimization
- EMR evaluation for faster documentation and correct code capture.
- Edits and rules for top PCP denial types (PCP assignment, referrals, bundling).
- Dashboards and reporting packages tailored to primary care KPIs.
Outcomes
↓ A/R days
Faster cash
↑ NCC/NCR
Higher collections
↓ Denials
Cleaner first pass
FAQ
Do you replace our EMR/PM?
No. We optimize your current stack.
How fast are results?
Most practices see impact within 60–90 days.
Can you train our MAs/Front Desk?
A: Yes, we offer coaching, SOPs, and staffing analyses
Ready to get started?
Let’s baseline your metrics and build a specialty‑tuned plan.