Preventive frequency denials
A physical or screening denied as too soon. We track last-service dates by payer rule and flag scheduling conflicts before the appointment.
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Primary Care medical billing services
Primary care runs on volume and thin margins, so every denied preventive visit and every unbilled care-management code shows up directly in cash flow. Our primary care billing is built around clean first-pass claims, preventive service tracking and the ancillary revenue most practices miss.
What makes primary care billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether primary care claims pay the first time.
- Preventive and problem-oriented visits on the same day require modifier 25 and separate documentation of the problem addressed.
- Annual wellness visits, screenings and counseling codes carry payer-specific frequency limits that vary between Medicare, Medicaid and commercial plans.
- In-office point-of-care tests (CLIA-waived) need modifier QW on many payers, and missing it is a silent denial source.
- Care-management services — CCM, TCM, remote patient monitoring (99453–99458) — are the fastest-growing revenue line in primary care and the least consistently billed.
Denials we see most in primary care
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Bundled sick-visit denials
The problem visit on a physical day denied as included. Modifier 25 with distinct documentation, and appeal with notes where payers deny by policy.
Point-of-care test rejections
CLIA-waived tests rejected for a missing QW modifier or CLIA number on the claim. Fixed at the scrubber so it never reaches the payer.
How Core MB bills for primary care
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new primary care providers runs in the same system, tracked live in your client portal.
- Clean-claim scrubbing tuned to primary care's preventive, E/M and in-office test mix.
- A standing care-management program that bills CCM, TCM and RPM every month for eligible patients.
- Plain-language monthly reporting so you see collections, denials and what to fix at the front desk.
Everything in the service
The full revenue cycle as standard for primary care 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
Primary Care billing questions
How do you reduce denials in a primary care practice?
Most primary care denials are preventable: frequency limits, missing modifiers and eligibility problems. We catch those before submission with payer-specific rules in our scrubber and verify eligibility ahead of visits.
Is care management worth billing for a small practice?
Yes. Even a solo practice with a few dozen eligible patients adds meaningful monthly revenue from CCM and remote monitoring, and the work is largely already being done.
Do you work with FQHCs and rural clinics?
Yes. We bill under the PPS and encounter-based rules those settings require, which differ from standard fee-for-service primary care.
How do we get started with Core MB for primary care 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 primary care providers can start at the same time.
Find out what your primary care 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.