Modifier 25 rejections
A sick visit on the same day as a physical is denied as inclusive. We document the distinct problem, apply modifier 25 correctly and appeal with the note when payers deny anyway.
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Family Medicine medical billing services
Family medicine bills the widest spread of services in healthcare: preventive visits, chronic care, acute problems, minor procedures and vaccines, often in the same week for the same patient. The revenue is in E/M accuracy and in capturing the care-management work most practices give away for free.
What makes family medicine billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether family medicine claims pay the first time.
- E/M leveling under the 2021 and 2023 guidelines turns on medical decision-making or total time, and under-coding 99213 where a 99214 is documented is the most common revenue leak we find.
- Preventive visits (99381–99397) billed alongside a problem-oriented E/M need modifier 25 and separate documentation, or the problem visit is denied as bundled.
- Chronic care management (99490, 99439), transitional care (99495–99496) and annual wellness visits (G0438, G0439) are frequently delivered but never billed.
- Vaccine administration codes (90460–90474) and the product codes must both appear, with the right counseling component for pediatric patients.
Denials we see most in family medicine
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Frequency limits on preventive services
Annual wellness and screening codes denied because a payer counts 365 days, not calendar years. We track eligibility dates per payer before the visit is booked.
Missing care-management elements
CCM and TCM denied for incomplete time or consent documentation. We give your team a one-page checklist and audit before the claim goes out.
How Core MB bills for family medicine
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new family medicine providers runs in the same system, tracked live in your client portal.
- Monthly E/M distribution review against documentation, so leveling is defensible and complete.
- A care-management capture program: identifying eligible patients and billing CCM, TCM and AWV every month.
- Payer-specific preventive schedules loaded into our scrubber so frequency denials stop at the front end.
Everything in the service
The full revenue cycle as standard for family medicine practices, priced on what we collect for you. Take all of it, or start with one piece such as AR recovery or credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Family Medicine billing questions
Why is family medicine billing harder than it looks?
Because the service mix is so broad. A single provider may bill E/M, preventive, procedures, immunizations and care management in one day, each with its own rules. Specialty practices repeat a narrow set of codes; family medicine never does.
Do you bill chronic care management for family practices?
Yes, and it is usually the biggest untapped revenue in a family practice. We identify eligible patients, set up the consent and time documentation, and bill monthly.
Can you help with E/M coding under the current guidelines?
Yes. We review the medical decision-making or time documented in each note and level the visit accordingly, and we feed back to providers where documentation is leaving revenue on the table.
How do we get started with Core MB for family medicine billing?
Send us your specialty, provider count and monthly claim volume through the quote form and we will come back with a written proposal. Transitions run alongside your current billing so nothing is dropped, and credentialing for new family medicine providers can start at the same time.
More in primary and general care
Find out what your family medicine billing is leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.