Elevate Your Practice Revenue with our Medical Billing Services
Unlock effortless medical billing and coding expertise tailored to your practice.
Medical Billing Specialities
EBS’s mission is to make a difference in healthcare by delivering
high-quality solutions that serve our practices, their patients, and their communities.
Key Steps in Medical Billing and Coding Services
Fully trained on your EMR/EHR
Our medical billing specialists know the workarounds of all the EHRs. We help you submit clean claims no matter which EHR you use.
Trusted by 500+ Healthcare Providers Nationwide
Our medical billing practice is built on industry certifications, transparent workflows, and a relentless commitment to recovering every dollar your practice has earned.
AAPC & AHIMA Certified
Every coder on our team holds active CPC, CCS, or specialty certification with annual continuing education credits.
HIPAA & SOC-2 Compliant
All data is encrypted at rest and in transit. We undergo annual HIPAA risk assessments and SOC-2 Type II audits.
$50M+ Revenue Recovered
Over $50 million in previously denied, underpaid, or unworked claims recovered for healthcare providers.
10+ Years of Experience
A decade of deep medical billing expertise spanning solo practices, multi-provider clinics, and hospital outpatient departments.
40+ Specialties Served
From Family Medicine and Pediatrics to Pain Management and Behavioral Health — we know your specialty's codes.
Real-Time KPI Dashboards
24/7 access to live collection dashboards with customizable reports on denial rates, A/R aging, and net collections.
Dedicated Support Team
Named account manager, coding supervisor, and A/R lead assigned to every client. No call centers, no ticket queues.
99.9% Uptime SLA
Cloud-hosted infrastructure with redundant backups, disaster recovery, and a 99.9% uptime service level agreement.
The 10-Step Medical Claim Lifecycle Management
From front-desk check-in to final bank deposit, here is how Emrys Billing Solutions optimizes every touchpoint of your billing workflow to maximize reimbursement and minimize delays.
Patient Registration & Demographics Scrubbing
Auditing patient demographics, contact details, guarantor info, and primary/secondary insurance card data to eliminate initial registration rejections.
Key Actions: Verify patient DOB, subscriber ID, group number, payer ID, and address accuracy against clearinghouse databases. Flag duplicate patient records and merge as needed.
Real-Time Eligibility & Benefits Verification
270/271 electronic transactions to verify active coverage status, copays, deductibles, coinsurance, and out-of-pocket maximums prior to patient visit.
Key Actions: Confirm plan effective dates, in-network status, referral requirements, COB order, and remaining deductible. Notify front desk of patient responsibility amounts before appointment.
Prior Authorization & Pre-Certification
Securing prior authorizations for diagnostic procedures, surgeries, and specialty visits to prevent non-covered service denials.
Key Actions: Submit prior auth requests via payer portals, track approval numbers, monitor expiration dates, and alert providers of pending or denied authorizations within 24 hours.
AAPC / AHIMA Certified Medical Coding
ICD-10-CM diagnosis mapping, CPT/HCPCS procedure coding, and CCI edit validation performed by certified specialty coders.
Key Actions: Assign highest-specificity ICD-10 codes, apply correct E/M levels based on documentation (MDM or Time-based), ensure HCC capture for risk adjustment, and validate code-to-modifier linkages.
Charge Entry & Pre-Submission Scrubbing
Applying specialty modifiers (Modifier 25, 59, KX, XE/XS/XP/XU) and checking Medically Unlikely Units (MUV) before claim transmission.
Key Actions: Run automated CCI edit scrubber, validate POS codes, verify NPI/taxonomy alignment, and check LCD/NCD frequency limitations for recurring services.
24-Hour Electronic Claim Filing (837P / 837I)
Direct electronic batch filing via ANSI 837P and 837I formats to clearinghouses and payer portals within 24 hours of encounter.
Key Actions: Monitor 277CA claim acknowledgements, resolve front-end rejections same-day, manage secondary/tertiary crossover claims, and track timely filing deadlines per payer contract.
ERA / EOB Auto-Posting & Contractual Audit (835)
Electronic Remittance Advice (835 ERA) auto-posting with strict audit against fee schedules to catch contractual underpayments.
Key Actions: Post payments and adjustments at line-item level, reconcile bank deposits against posted amounts, identify underpayments vs contracted rates, and flag zero-pay EOBs for immediate follow-up.
Denial & Rejection Management with Appeals
Immediate correction of claim rejections and submission of formal written appeals citing LCD/NCD medical necessity guidelines.
Key Actions: Categorize denials by CARC/RARC codes, draft provider-specific appeal letters with clinical documentation, escalate through payer grievance channels, and track appeal outcomes for trend analysis.
Aggressive Aging A/R Follow-Up (60, 90, 120+ Days)
Dedicated A/R phone calls to payer representatives to resolve unpaid balances and bring practice Days in A/R under 22 days.
Key Actions: Prioritize high-dollar aging claims, resolve COB (Coordination of Benefits) issues, obtain payer reference numbers for every call, and escalate with supervisor callbacks for stalled claims.
Patient Statements & Digital Payment Portal
Clear, user-friendly monthly statements with online credit card / ACH portal links and patient billing support hotline.
Key Actions: Generate itemized statements after insurance adjudication, send automated payment reminders (email, text, mail), offer payment plan setup, and provide bilingual patient support representatives.
The 6 Pillars of Our Medical Billing Practice
Designed to protect practice revenue, reduce administrative overhead, and eliminate coding errors across every stage of the revenue cycle.
1. Certified Charge Scrubbing
AAPC/AHIMA coders review patient charts to ensure correct CPT, ICD-10, and specialty modifier pairings before filing.
- Specialty Modifiers: 25, 59, KX, XE/XS/XP/XU
- Correct Coding Initiative (CCI) edit scrubbing
- Medically Unlikely Units (MUV) check
- E/M level validation (MDM & Time-Based)
2. 24-Hr Electronic Claims
Rapid electronic transmission to commercial (BCBS, Aetna, Cigna, UHC) and government (Medicare/Medicaid) clearinghouses.
- Primary, secondary, and tertiary claim routing
- Real-time clearinghouse rejection resolution
- Timely filing limit tracking per payer contract
- 277CA acknowledgement monitoring
3. ERA / EOB Payment Posting
Automated Electronic Remittance Advice (ERA) posting and manual EOB reconciliation down to line-item detail.
- Contractual write-off verification vs fee schedule
- Copay, deductible, and coinsurance allocation
- EHR bank deposit reconciliation
- Underpayment identification & recovery
4. Denial Appeals & Recovery
Systemic analysis of claim rejections with custom appeal letters citing LCD/NCD medical necessity guidelines.
- First and second-level formal payer appeals
- Pre-authorization & medical necessity documentation
- Denial root-cause tracking & front-desk feedback
- External review & state insurance department escalation
5. Aggressive Aging A/R Recovery
Dedicated A/R specialists work unpaid claims older than 30, 60, 90, and 120+ days to recover lost revenue.
- Direct phone follow-up with insurance reps
- COB (Coordination of Benefits) resolution
- Reduction of Days in A/R down to <22 days
- Write-off analysis & bad debt minimization
6. Patient Balance Management
Friendly, professional patient statements with online portal payment links and empathetic customer service phone support.
- Customized electronic statement billing cycles
- Patient inquiry resolution line
- Payment plan setup and compliance
- Text & email payment reminders
Deep Knowledge Across All Major Insurance Payers
Each payer has unique billing rules, timely filing limits, and appeal processes. Our team is trained on every major commercial and government payer in the United States.
- ✦ LCD/NCD medical necessity compliance
- ✦ MIPS / QPP quality reporting
- ✦ ABN (Advance Beneficiary Notice) management
- ✦ Medicare Secondary Payer (MSP) rules
- ✦ Timely Filing: 12 months from DOS
- ✦ State-by-state Medicaid fee schedule compliance
- ✦ Managed Medicaid MCO routing
- ✦ EPSDT (pediatric screening) billing
- ✦ Prior auth for non-emergency services
- ✦ Timely Filing: Varies by state (90-365 days)
- ✦ BCBS plan-specific modifier requirements
- ✦ BlueCard / Inter-Plan routing
- ✦ Pre-certification for surgical procedures
- ✦ Contracted rate underpayment audits
- ✦ Timely Filing: 90-180 days (plan-dependent)
- ✦ Optum portal claim status monitoring
- ✦ UHC-specific prior auth requirements
- ✦ UMR & Oxford sub-plan routing
- ✦ Behavioral health carve-out expertise
- ✦ Timely Filing: 90 days from DOS
- ✦ Aetna Availity portal integration
- ✦ Precertification for diagnostic imaging
- ✦ Coordination with Aetna Better Health (Medicaid)
- ✦ Global surgical package compliance
- ✦ Timely Filing: 90 days (commercial)
- ✦ Cigna eviCore prior auth submissions
- ✦ In-network referral tracking
- ✦ Cigna behavioral health authorization
- ✦ Multi-plan routing for ASO groups
- ✦ Timely Filing: 90-180 days
- ✦ TRICARE Prime & Select claim routing
- ✦ DoD referral & authorization compliance
- ✦ Humana Military portal integration
- ✦ TRICARE-specific modifier rules
- ✦ Timely Filing: 1 year from DOS
- ✦ State-specific WC fee schedule adherence
- ✦ Employer & adjuster authorization tracking
- ✦ First Report of Injury documentation
- ✦ Utilization review & IME coordination
- ✦ Timely Filing: State-dependent (30-180 days)
Common Insurance Denial Codes We Systematically Resolve
Our experienced billing team turns rejected claims into paid revenue using proven appeal templates, clinical documentation support, and clearinghouse rule updates. Below are the top 10 denial codes we encounter and resolve daily.
Procedure Code Inconsistent with Modifier / Diagnosis
EBS Resolution: We audit chart documentation to verify modifier eligibility (Modifier 25, 59, XE/XS) and resubmit with supporting medical notes and correct diagnosis code linkage.
Claim Lacks Required Information or Coding Detail
EBS Resolution: Automated pre-submission clearinghouse rules identify missing NPIs, taxonomy codes, or prior authorization numbers before filing. Claims are corrected and resubmitted same-day.
Non-Covered Service / Deemed Not Medically Necessary
EBS Resolution: We draft formal Level 1 & Level 2 appeals attaching specific Medicare Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and peer-reviewed clinical guidelines.
Procedure Code Bundled into Primary Service (CCI Edit)
EBS Resolution: We verify distinct procedural service guidelines, append NCCI unbundling modifiers (59, XE, XS, XP, XU) when appropriate, and request claim re-adjudication with supporting operative notes.
Exact Duplicate Claim / Service Previously Adjudicated
EBS Resolution: We verify whether the claim is a true duplicate or a legitimately separate encounter. If separate, we resubmit with Condition Code 7 (replacement claim) or append a corrected claim indicator.
Patient Responsibility — Deductible Amount
EBS Resolution: We verify the patient's remaining deductible against the plan's accumulator, confirm COB order, and transfer the accurate balance to the patient statement cycle with clear itemization.
Claim Not Covered by This Payer / Forward to Correct Plan
EBS Resolution: We re-verify patient eligibility, identify the correct primary payer through COB investigation, update insurance information in the PM system, and refile to the appropriate plan within timely filing limits.
Impact of Prior Payer Adjudication Including Patient Payments
EBS Resolution: We reconcile primary EOB payments, apply correct patient responsibility amounts, and file secondary claims with complete primary payer adjudication data (CAS segments, payment amount, and claim adjustment reason codes).
Timely Filing Limit Has Expired
EBS Resolution: We gather proof of timely submission (clearinghouse transmission reports, 277CA receipts, prior correspondence) and submit a formal appeal demonstrating the claim was originally filed within contractual deadlines.
Charges Exceed Your Contracted / Legislated Fee Schedule
EBS Resolution: We audit fee schedule agreements, verify that contractual adjustments are applied correctly (and not excessively), and escalate underpayment disputes to the payer's provider relations department with supporting contract documentation.
Enterprise-Grade Billing Infrastructure & Security
Our medical billing platform is built on a modern, secure, and interoperable technology stack designed to integrate with your existing practice management systems while meeting the highest healthcare compliance standards.
HIPAA Compliance Framework
Full HIPAA Privacy Rule, Security Rule, and Breach Notification Rule adherence with documented policies and procedures.
- • Annual HIPAA Risk Assessment & Remediation
- • Business Associate Agreements (BAAs) with all vendors
- • Mandatory staff HIPAA training & certification
- • Incident response plan with 60-day breach notification
EHR / PM System Integration
Seamless bi-directional connectivity with 50+ Electronic Health Record and Practice Management platforms.
- • Epic, Athenahealth, eClinicalWorks, Kareo
- • AdvancedMD, DrChrono, Practice Fusion, NextGen
- • Cerner, MEDITECH, Allscripts, Greenway
- • HL7 FHIR & API-based data exchange
Cloud Infrastructure & Uptime
Hosted on HITRUST-certified cloud infrastructure with multi-region redundancy and automated failover.
- • 99.9% uptime SLA guarantee
- • AES-256 encryption at rest & TLS 1.3 in transit
- • Daily automated backups with 90-day retention
- • SOC-2 Type II audited data center operations
Clearinghouse Connectivity
Direct connections to leading clearinghouses for real-time claim submission, status tracking, and ERA retrieval.
- • Availity, Change Healthcare (Optum), Trizetto
- • Office Ally, Claim.MD, Waystar
- • ANSI X12 837P/837I/835/277/270/271 transaction sets
- • Real-time 999/277CA acknowledgement monitoring
Analytics & Reporting Engine
Comprehensive reporting suite with real-time dashboards, automated alerts, and executive-level KPI summaries.
- • Denial rate trend analysis by payer & code
- • A/R aging bucket reports (0-30, 31-60, 61-90, 90+)
- • Net collection ratio & gross collection ratio tracking
- • Provider productivity & encounter volume dashboards
Regulatory Compliance Updates
Proactive monitoring of CMS, AMA, and state-level regulatory changes affecting medical billing and coding.
- • Annual ICD-10-CM / CPT code set updates (Oct 1 / Jan 1)
- • CMS MPFS fee schedule updates
- • No Surprises Act & Good Faith Estimate compliance
- • State-specific balance billing & surprise billing laws
In-House Billing Staff vs. Emrys Billing Solutions
Compare the total operational costs, clean claim performance, compliance risk, and financial outcomes of internal billing staff vs. outsourcing to EBS.
| Performance & Financial Metric | In-House Billing Staff | Emrys Billing Solutions (EBS) |
|---|---|---|
| Clean Claim First-Pass Rate | 82% – 88% (High rework cost) | 98.7% (Guaranteed AAPC Scrubbing) |
| Average Days in A/R | 45 – 65 Days | < 22 Days |
| Cost Structure & Overhead | Fixed Salaries + Benefits + Software Subscriptions | Performance-Based % (Zero Overhead) |
| AAPC / AHIMA Certified Coders | Rare / Expensive to Hire & Retain | 100% Certified Specialty Coders |
| Staff Turnover Risk | High Risk (Cash flow stops when billing staff leaves) | Zero Downtime (Full Dedicated Team) |
| Denial Appeal Rate | 30% – 50% written off due to lack of time | 100% Aggressive Denial Appeal Rate |
| HIPAA Compliance & Audits | Self-managed; often incomplete or outdated | Annual HIPAA Risk Assessment & SOC-2 Audit |
| Technology & Software Costs | $500 – $2,000+/month for PM/clearinghouse licenses | Included — Zero Additional Software Fees |
| Reporting & KPI Dashboards | Manual Excel reports; limited visibility | Real-Time 24/7 KPI Dashboards |
| Scalability for Practice Growth | Must hire additional staff; 3-6 month training ramp | Instant Scalability — No Hiring Needed |
In-Depth Billing for 40+ Medical Specialties
Every specialty has unique CPT ranges, modifier requirements, documentation thresholds, and payer policies. Our certified coders are trained in the specific billing nuances of your practice type.
Internal Medicine
Complex E/M coding for chronic disease management, AWV (Annual Wellness Visit), CCM (Chronic Care Management), and preventive screenings.
Key Codes: 99213-99215, G0438/G0439, 99490, 99491
Pediatrics
Well-child visit (WCV) coding, immunization administration (90460/90461), EPSDT screenings, and developmental screening billing.
Key Codes: 99381-99395, 90460, 96110, 99173
Pain Management
Interventional pain procedure coding (nerve blocks, epidural steroid injections, RFA), fluoroscopy guidance billing, and prior auth management.
Key Codes: 64483, 64493-64495, 77003, 64635
Physical Therapy
Time-based CPT unit billing (8-minute rule), KX modifier compliance for therapy caps, functional limitation reporting (G-codes), and plan of care tracking.
Key Codes: 97110, 97140, 97530, 97035, Modifier KX/GP
Urgent Care
High-volume E/M coding, in-house lab and radiology billing (CLIA waived tests), laceration repair coding, and workers' comp first injury reports.
Key Codes: 99201-99215, 12001-12007, 71046, 87880
Behavioral Health / Psychiatry
Psychotherapy add-on coding (90833/90836/90838), psychiatric diagnostic evaluation, medication management E/M, and telehealth billing.
Key Codes: 90837, 90833, 90791, 99213+90833, Modifier 95
Ophthalmology
Cataract surgery billing (66984), retinal imaging (92134), OCT scans, visual field testing, and anti-VEGF injection coding.
Key Codes: 66984, 92134, 92250, 67028, J2778
Dermatology
Skin biopsy coding (11102/11104), Mohs surgery billing (17311-17315), destruction of lesions, and pathology specimen coordination.
Key Codes: 11102, 17000-17004, 17311, 88305
Cardiology
Cardiac catheterization coding, echocardiogram billing (93306), stress test procedures, pacemaker/ICD implant coding, and Holter monitor reporting.
Key Codes: 93458, 93306, 93015, 33208, 93224
OB/GYN
Global obstetric package billing (59400/59510), antepartum visit tracking, ultrasound coding, and gynecological procedure billing.
Key Codes: 59400, 59510, 76801, 58661, 57454
General Surgery
Surgical global period management, modifier 58/78/79 compliance, assistant surgeon billing, and operative report-based coding.
Key Codes: 47562, 49505, 43239, Modifiers 58/78/79/80
Radiology & Imaging
Technical & professional component billing (TC/26), CT/MRI/X-ray coding, contrast administration, and radiologist supervision level compliance.
Key Codes: 70553, 74177, 71046, Modifiers TC/26
Real Client Case Studies & Outcomes
See how Emrys Billing Solutions has transformed revenue cycle performance for practices across the country with measurable, auditable results.
Midwest Internal Medicine Associates
This 3-provider IM practice was struggling with 55+ days in A/R, a 78% clean claim rate, and $180K in aging receivables over 120 days. After 90 days with EBS:
"EBS recovered nearly $142K in aging receivables we had written off. Our cash flow improved dramatically within the first 60 days." — Practice Administrator
Southeast Pain & Spine Center
This interventional pain practice faced frequent CO-4 and CO-97 denials on nerve block and epidural injection claims due to improper modifier usage and CCI bundling edits. After EBS onboarding:
"Our injection claim denials dropped by 94%. EBS's modifier and CCI edit expertise is far beyond what our previous billing company offered." — Medical Director
Pacific Northwest Medical Group
This 8-provider multi-specialty group (Family Medicine, Cardiology, Dermatology) experienced chronic billing staff turnover, inconsistent coding quality, and $350K+ in stale A/R. After transitioning to EBS:
"Switching to EBS eliminated our billing staff turnover problem completely. We went from 3 billing hires in 2 years to zero — with better results across the board." — CEO
Estimate Your Practice's Revenue Leakage
Use our interactive calculator to estimate how much revenue your practice may be losing due to claim denials, slow A/R, and undercoding.
Enter Your Practice Details
Estimated Monthly Revenue Impact
Your 4-Week Onboarding Journey with EBS
We handle 100% of the transition process so your front-desk and clinical teams experience zero disruption to daily operations. Here's what to expect week by week.
Discovery & System Access
Kickoff call, BAA execution, secure EHR/PM system access setup, payer credentialing audit, and aged A/R snapshot analysis.
Data Migration & Configuration
Fee schedule import, payer enrollment verification, clearinghouse enrollment, ERA/EFT setup, and custom workflow configuration.
Parallel Processing & QA
Side-by-side claim processing with your existing workflow, quality assurance audits, coding accuracy validation, and staff training sessions.
Full Go-Live & Support
Complete transition to EBS billing operations, aged A/R recovery campaign launch, KPI dashboard activation, and dedicated account manager introduction.
Frequently Asked Questions About Medical Billing
Have questions about switching your billing services to EBS? Here are direct, detailed answers to the most common practice manager inquiries.
Ready to Increase Your Net Collections?
Stop leaving money on the table. Join 500+ healthcare providers who trust Emrys Billing Solutions to optimize their revenue cycle, eliminate denials, and accelerate cash flow.
Get our complimentary 30-Point Practice RCM Audit. We'll analyze your aging A/R, denial patterns, coding accuracy, and payer mix — with zero obligation.
Comprehensive Medical Billing Services
Maximize your practice's revenue, minimize claim denials, and accelerate your cash flow with our expert, end-to-end medical billing solutions tailored for healthcare providers nationwide.
Why Outsource Your Medical Billing?
In today’s rapidly changing healthcare landscape, managing in-house medical billing is becoming increasingly difficult. Between constantly evolving ICD-10 coding regulations, stringent insurance payer policies, and staff turnover, practices are losing thousands of dollars to avoidable claim denials and delayed payments.
At Emrys Billing Solutions, we provide full-scale Revenue Cycle Management (RCM). By outsourcing your billing to our dedicated team of US-based experts, you drastically reduce your administrative overhead and ensure a 99% clean claim acceptance rate. We handle the paperwork, so you can focus strictly on what matters most: patient care.
Our 6-Step Medical Billing Process
We leave no money on the table. Our systematic approach ensures every claim is accurately coded, aggressively tracked, and successfully paid.
Demographics & Eligibility
We verify patient insurance eligibility and coverage details before the appointment occurs. By catching inactive coverage early, we prevent downstream denials and secure your reimbursement.
Medical Coding Verification
Our AAPC-certified coders review your clinical documentation to ensure the correct CPT, HCPCS, and ICD-10 codes are applied, minimizing audit risks while legally maximizing your revenue.
Charge Entry & Scrubbing
Charges are entered swiftly and run through our advanced claim scrubbing software. This double-check system catches formatting and coding errors before the claim ever reaches the payer.
Electronic Claim Submission
Clean claims are submitted electronically via our integrated clearinghouse directly to Medicare, Medicaid, and commercial payers, resulting in a 99% first-pass acceptance rate.
Payment Posting (ERA/EOB)
As payments return, we meticulously post Electronic Remittance Advices (ERAs) and manual EOBs to patient accounts, ensuring your financial ledgers are 100% accurate and up to date.
Denial Management & AR
We aggressively pursue unpaid or aged claims. Our AR team investigates the root cause of any denial, immediately files strategic appeals, and works the accounts receivable until you are paid.
The Emrys Advantage
Choosing the right medical billing company is a critical financial decision. We integrate directly with your existing EHR/EMR systems, meaning you don't have to change the way you work.
Furthermore, if your practice is facing out-of-network issues, our in-house Provider Credentialing team will handle all your payer enrollments and contract negotiations.
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Transparent Financial Reporting
Access custom daily, weekly, and monthly dashboards to track your financial health.
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Specialty-Specific Expertise
We serve practices of all types. View our Supported Specialties for more details.
Frequently Asked Questions
Common questions about our medical billing services.
What is a "Clean Claim Rate"?
A clean claim rate is the percentage of medical claims that are accepted and processed by insurance payers on the very first submission without needing edits or appeals. Our meticulous claim scrubbing process ensures a 99% clean claim rate for our clients, which means you get paid much faster.
Do I need to change my current EHR/EMR software?
No, you do not. Our billing specialists are proficient in all major electronic health record systems (including Epic, Athenahealth, eClinicalWorks, and more). We seamlessly integrate into your current workflow without disrupting your clinical staff.
How do you handle old, unpaid claims (Accounts Receivable)?
We do not just handle new claims. Our AR recovery team will audit your aging reports, identify exactly why old claims were denied or ignored, and aggressively appeal them. We work diligently to recover money that your practice has already earned.
Stop Losing Revenue to Denials
Let Emrys Billing Solutions handle the complexities of medical billing so you can focus on providing exceptional care to your patients.