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Primary Care Billing

Billing for primary care practices where every dollar and every minute matter.

High-volume E/M billing, preventive visits split cleanly from problem-oriented, and value-based reporting handled without slowing your providers.

▤Family medicine or internist visit
Specialty Challenges

Primary care billing lives or dies on volume, splits, and quality reporting.

E/M leveling accuracy

99213 vs 99214 is a documentation call, not a guess; consistent underleveling leaves 6-figure revenue on the table each year.

Preventive + problem visits

Annual wellness and preventive visits collide with same-day problem-oriented E/M; the 25 modifier and split billing must be right or one line gets denied.

AWV and IPPE coding

G0402, G0438, G0439 have strict frequency and eligibility rules; missing a HRA or care plan element voids the visit.

Chronic care & RPM

CCM (99490, 99439), PCM, and RPM (99453-99458) require documented time and consent; unbilled time is unbilled revenue.

Vaccines & admin codes

Product J-codes plus admin codes (90460-90474) with correct components and VFC status; payer rules vary sharply.

MIPS and value-based reporting

Quality, PI, and Cost measures affect fee-schedule adjustments 2 years out; measure selection and denominator hygiene matter now.

Common Denials

The reason codes we see most, and how we prevent them.

CO-97
Bundled with another service
Preventive and problem-oriented visits on the same day need modifier 25 with clean documentation.
CO-B7
Provider not eligible for this service
Wellness codes tied to Medicare eligibility windows; we validate before scheduling.
CO-45
Charge exceeds fee schedule
Fee schedule loads audited quarterly against payer contracts; contractual write-offs kept clean from denials.
PR-96
Non-covered service
Preventive-only patients billed for problem-oriented visits without notice; ABN and NOA workflow standardized.
Workflow

Built for volume without cutting corners.

1
Eligibility & benefits
Verified nightly for the next day; preventive vs problem-oriented eligibility flagged for the front desk.
2
Same-day charge capture
Encounters closed within 24 hours; open-note reports go to your practice manager, not lost in the queue.
3
E/M leveling review
Level audits sampled weekly; both underleveling and overleveling flagged with documentation guidance.
4
Scrub & submit
Preventive/problem splits, 25 modifier, and vaccine admin coding validated at scrub.
5
A/R follow-up & patient balance
Aged buckets worked bucket-by-bucket; patient statements sent on your cadence with clear, plain-language balances.
Services for Primary Care

What we run for you

FAQ

Primary care billing questions

Can you split preventive and problem-oriented visits without triggering denials?+
Yes. Modifier 25 is applied only where documentation supports a separately identifiable E/M service, and we run payer-specific rules for preventive pairings.
Do you handle AWV, IPPE, and subsequent wellness visits?+
Yes. Frequency limits, HRA, and personalized prevention plan requirements are checked before submission so the visit is not rejected.
Can you bill chronic care management and RPM alongside our office visits?+
Yes. Time tracking, consent capture, and code stacking (CCM, PCM, RPM) are supported without double-billing risk.
Do you support MIPS reporting?+
We help select measures aligned with your specialty and workflow, and we track denominator populations so quality scores are defensible.

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