ServicesThe revenue cycle

Medical Billing and Coding Services for US Healthcare Providers

Medical coding turns a visit into codes a payer understands. Medical billing turns those codes into a claim and the claim into money in your account. VisMed is a medical billing and coding company that does both, with certified coders and experienced billers working as one team inside your own EHR.

Why VisMed
Medical billing and coding — every encounter coded from the note
A medical coder marking a line on an encounter form with a highlighter, a coding reference open beside it.
01Overview

What our medical billing and coding services include

Reviewed by the VisMed revenue cycle team

Medical coding is reading the provider’s note and assigning the codes that describe it: ICD-10-CM for the diagnosis, CPT and HCPCS Level II for what was done, and modifiers for the circumstances. Medical billing is everything that happens with those codes afterward: building the claim from the superbill or charge, scrubbing it, sending it, posting what the payer pays, and following up on what it does not.

The two are often bought from different vendors, or split between a coder and a biller who rarely talk. That split is where a lot of money goes missing. A coding error shows up weeks later as a billing denial, and the person who works the denial is not the person who could have prevented it. Our medical billing and coding services keep both under one team, so every denial goes back to the step that caused it.

We provide healthcare billing services, physician billing and physician coding for doctors, group practices, clinics, hospitals, laboratories, therapists and behavioral health providers across the US. The claims follow the same rules everywhere. What changes is the specialty, the payers, and how many places a claim can go wrong.

Medical billing

  • Patient registration and insurance eligibility verification
  • Charge entry and claim scrubbing
  • Electronic claim submission (CMS-1500 and UB-04)
  • ERA and payment posting
  • Denial management and A/R follow-up
  • Patient statements and billing support
  • Monthly billing reports

Medical coding

  • CPT, ICD-10-CM and HCPCS coding
  • E/M level selection by MDM or time
  • Modifier assignment
  • Coding audits and reviews
  • Specialty-specific coding by CPC and CCS coders
  • Documentation feedback to providers
02Billing

Medical billing services

Everything between a coded visit and money in your account: clean claims out, payments posted, and every denial and open balance followed to an answer.

  1. Patient registration and insurance verification

    Patient demographics and insurance entered correctly, once, and coverage checked before the visit: active plan, copay, deductible, coinsurance, the patient responsibility to collect, and whether the service needs prior authorization. A typo in a member ID is still one of the most common reasons a claim bounces, and it is the cheapest one to prevent.

  2. Charge entry and claim scrubbing

    Every charge entered with the right place of service, rendering provider NPI, units and fee schedule, then reconciled against the day’s schedule, so charge capture is complete and no visit goes unbilled. Before it leaves, each claim is scrubbed against NCCI edits, medical necessity rules and the specific payer’s policies, and anything that would bounce is fixed first.

  3. Electronic claim submission

    Claims go out electronically through your clearinghouse within a day or two of the visit, on the CMS-1500 for professional services or the UB-04 for facilities. We read every clearinghouse and payer acknowledgment, fix every claim rejection the same day, and keep each payer’s timely filing limit in view.

  4. Payment posting

    Electronic remittance advice (ERA) and paper explanation of benefits (EOB) forms posted line by line, with payments arriving by electronic funds transfer (EFT), with every payment compared with your contracted rate. Contractual adjustments are checked, underpayments are flagged and appealed, and the patient’s share moves to their account correctly, so patient statements are right the first time.

  5. Denial and A/R follow-up

    Every denial read, traced to its cause, then corrected and resubmitted or appealed with the documentation attached. Open claims are worked by age, dollar value and payer deadline, with a phone call when the portal shows nothing useful. The cause of each denial goes back upstream, to coding or the front desk, so it stops recurring.

  6. Patient statements and billing support

    Clear patient statements that show what insurance paid and why the patient owes the rest, sent on a regular cycle with an easy way to pay. Patients with billing questions get a real answer, and payment plans follow the policy you set.
03Coding

Medical coding services

Certified coders, matched to your specialty, coding every encounter from the note. We look for undercoding as hard as overcoding, and bill what the documentation supports.

CPT, ICD-10-CM, and HCPCS coding

Codes and credentialsCPT · ICD-10-CM · HCPCS Level II

Checked againstThe note, NCCI edits, LCDs and NCDs, payer policy

Every encounter coded from the note: the diagnosis that justifies the service, the procedure that was performed, and the supplies, drugs and equipment billed on HCPCS codes. Diagnoses are coded to the specificity the note supports, which is what medical necessity edits look for. For hospital inpatient claims, the same codes drive the DRG, so accurate medical coding decides the payment.

E/M coding

Codes and credentialsOffice visits 99202–99215, plus hospital, nursing facility and home E/M

Checked againstAMA E/M guidelines: medical decision making or total time

E/M levels are chosen by medical decision making or by total time on the date of service, whichever the note supports. This is where undercoding hides: a level three billed for a level four visit never denies, it just pays less every time.

Modifier assignment

Codes and credentials25 · 59 · XU · 26/TC · 95 · GP · KX and others

Checked againstNCCI procedure-to-procedure edits, payer modifier policies

Modifiers tell the payer why two services on the same day should both be paid, who performed which part, or how the visit happened. Used wrongly, they cause denials or audit risk. Used correctly, they are the difference between a bundled service and a paid one.

Coding audits

Codes and credentialsBefore-billing and after-payment samples

Checked againstDocumentation against the codes billed

We sample encounters against their notes on a regular cycle, looking for undercoding as well as overcoding. Each provider gets short, specific feedback on what the note needed to support the right code, and you get a summary of coding accuracy: what we found and what changed.

Specialty-specific coding by certified coders

Codes and credentialsCPC (AAPC) and CCS (AHIMA) credentialed coders

Checked againstSpecialty rules, global periods, payer policy

Coders are matched to your specialty, so the person coding your cardiology, behavioral health or physical therapy claims works that specialty every day: global surgical periods, timed therapy units, add-on codes, and the payer policies that only matter in that field.

04One team

Why medical billing and coding work better together

Coding decides what a claim says. Billing decides whether it gets paid. When they are split, each side only sees half of the problem: the coder never hears which codes were denied, and the biller cannot fix a note. The same denial comes back month after month because nobody owns the whole thing.

When one team does both, a denial for medical necessity goes straight back to the coder who chose the diagnosis, and an underpayment on a modifier goes back to the person who set it. Fixes happen at the source, and the clean claim rate goes up because the people sending claims are learning from the ones that came back.

Billing and coding split between vendors, compared with one team doing both
AreaSplit between vendorsOne team for both
Coding denialsWorked by a biller who cannot change the code or the noteSent back to the coder, corrected, and fixed at the source
UndercodingNever shows up, because nothing deniesFound in coding audits and fed back to providers
Provider feedbackRare, and usually after the money is lostShort notes on what the documentation needed
AccountabilityEach vendor points to the otherOne team owns the claim from note to payment
ReportingTwo reports that do not matchOne monthly report from coding through collections
05Process

Our medical billing and coding process

Nine checkpoints from the front desk to the monthly report, run in five steps. Each one has an owner on our side.

  1. 01Registration
  2. 02Verification
  3. 03Coding
  4. 04Charge entry
  5. 05Claim scrubbing
  6. 06Submission
  7. 07Payment posting
  8. 08Follow-up
  9. 09Reporting

Step 1: Patient registration and insurance verification

Clean data at the front end prevents more denials than anything that happens later. Demographics and insurance are captured correctly, coverage and benefits are checked before the visit, and services that need prior authorization are flagged while there is still time to get it.

What we doVerify eligibility and benefits, flag authorization needs, correct registration errors

What you doSchedule the patient and collect the copay at the visit

Step 2: Medical coding and charge entry

Certified coders read the note and assign ICD-10-CM, CPT, HCPCS and modifiers. Charges are entered and reconciled against the schedule, so every visit ends as a claim, a no-show, or a documented reason.

What we doCode from the note, enter charges, query the provider when the note falls short

What you doSign notes promptly and answer the occasional coding question

Step 3: Claim scrubbing and submission

Each claim is checked against NCCI edits, medical necessity rules and the payer’s policies before it leaves. Clean claims go out electronically within a day or two of the visit, and clearinghouse rejections are fixed the same day.

What we doScrub, submit and track every claim to payer acknowledgment

What you doNothing, unless a payer needs a document only you have

Step 4: Payment posting and denial follow-up

ERAs and EOBs are posted line by line against your contracted rates. Denials are worked to their cause and corrected or appealed inside the filing window. Open A/R is followed up by age, value and payer deadline.

What we doPost payments, appeal underpayments, work every denial and open claim

What you doApprove write-offs and patient balance policies

Step 5: Monthly reporting

Every month you get a short report in plain English: what was billed and collected, what was denied and why, what is aging, and what we are doing next. Clean claim rate, denial rate, days in A/R and net collection rate are trended so you can see direction, not just a snapshot. Weekly summaries come in between.

What we doWrite the report and walk you through it

What you doRead it, ask questions, and tell us what you want to see

06Who we serve

Who we provide medical billing and coding services for

From one physician to a hospital’s professional billing. The claim rules are the same; the specialty, volume and payers are not.

  1. Physicians and individual providers

    Medical billing services for physicians, nurse practitioners and physician assistants in solo practice. We become your billing office, so you are not coding claims at night, and every visit is billed at the level your note supports.

  2. Small and medium practices

    Medical billing and coding services for small practices and group practices that have outgrown one biller. We take over billing and coding entirely or work alongside your team on coding, denials or old A/R.

  3. Large medical groups and hospitals

    Medical group billing services and hospital billing services for multi-specialty groups and hospital-employed physicians, with coders matched to each specialty and reporting by provider, location and payer. Professional and facility claims, CMS-1500 and UB-04.

  4. Mental and behavioral health therapists

    Mental health and behavioral health billing services: psychotherapy and psychiatric codes, time-based sessions, telehealth modifiers, add-on codes and authorization limits for psychologists, counselors, social workers and psychiatric providers.

  5. Physical therapists

    Physical therapy billing services: timed units under the 8-minute rule, GP modifiers, plan-of-care certifications, visit limits and the KX threshold, for PT, OT and speech therapy practices.

  6. Clinics and medical laboratories

    Clinic billing services and laboratory billing services for urgent care, multi-specialty clinics, FQHCs and clinical laboratories: high-volume visits, panels, medical necessity edits and the diagnosis pointers lab claims depend on.
07Payers

Insurance payers we bill

Medicare billing, Medicaid billing and commercial insurance billing make up most of the work, along with the managed care plans and military and veterans programs. We also handle the payers many practices find hardest: workers’ compensation billing and personal injury claims. If your patients carry it, we bill it.

Payer names are trademarks of their owners. VisMed is not affiliated with or endorsed by any payer.

08Problems we solve

Billing and coding problems we solve

Where billing and coding usually lose money, and what we do about each one.

  1. Claim denials from coding errors

    A diagnosis that does not support medical necessity, a missing modifier, a code that bundles into another: coding denials are among the most common and the most preventable. Our coders work from the note, claims are scrubbed against payer edits before they go out, and every coding denial goes back to the coder so the same mistake is not repeated. Fewer claim denials follow from that loop, not from working harder at appeals.

  2. Rejected and late claims

    Rejections are claims the payer never accepted, usually because of a registration or format problem, and they are easy to lose because they never become a denial. We read every clearinghouse report, fix rejections the same day, and keep each payer’s timely filing limit on a calendar so no claim ages past it.

  3. Under-coding and missed revenue

    Undercoding is the quiet leak. A visit billed one level too low gets paid, so nobody looks at it again, and across a year that difference is often the largest single loss we find. Our coding audits look for it on purpose, and providers get a one-line note on what would have supported the higher level. We bill what the note supports, never more.

  4. Slow insurance payments

    Faster insurance payments start with knowing why they are slow. It is usually claims going out late, rejections nobody noticed, or denials waiting in a pile. Claims leave within a day or two of the visit, rejections are fixed the same day, and A/R is worked by age and value, with a phone call to the payer when a claim has stalled.

  5. Coding compliance risk

    Overcoding is an audit risk with your name on it. Payers and CMS treat repeated patterns as fraud, waste, and abuse, and under the False Claims Act the consequences are serious. Our coders follow the official coding guidelines, flag notes that overreach as well as notes that undersell, and keep the codes matched to the chart. That is the only position that holds up in a payer audit.

09Why VisMed

Why outsource medical billing and coding to VisMed

In-house vs outsourced medical billing comes down to coverage and expertise. One in-house biller knows your practice, but not every payer rule, and when they leave or take a vacation the claims stop. A medical billing outsourcing company brings certified coders, billers and denial specialists, covers absences, and is paid on what it collects. A good medical billing partner will also tell you when your in-house team is doing well and only needs help with one part.

  1. Certified medical coders

    Our coders hold CPC or CCS credentials and are matched to your specialty, so the person coding your claims works that specialty every day and knows its edits, global periods and payer policies.

  2. Clean claims from the first submission

    Registration checked, eligibility verified, codes matched to the note, and every claim scrubbed against the payer’s edits before it goes out. That is how a higher clean claim rate is built: getting it right the first time is faster and cheaper than fixing it after a denial.

  3. HIPAA-compliant billing

    We work under a signed Business Associate Agreement, inside your own systems, and keep no patient information (PHI) on our own servers. Access is limited to the people working your account.

  4. Transparent monthly reports

    A monthly report in plain English with the numbers that matter, trended over time, and a weekly summary in between. Because we work inside your system, you can also open any claim on any day and see exactly what we did.

  5. Works with your EHR

    We work in the EHR or EMR and practice management system you already use, including athenahealth, eClinicalWorks, Epic, NextGen, AdvancedMD, Tebra, ModMed, WebPT and SimplePractice. There is no migration, no new portal, and nothing to move back if you ever leave.
10Contact

Get started with VisMed medical billing and coding services

Start with a free AR audit: six months of aging and denials, quantified as monthly leakage with a recovery estimate, in two to three business days. Yours to keep.

or write directly hello@vis.med

11Questions

Medical billing and coding FAQs

What providers ask about billing and coding, and about working with VisMed, on the first call.

What do your medical billing and coding services include?

VisMed’s medical billing and coding services include eligibility verification, CPT, ICD-10-CM and HCPCS coding, E/M and modifier assignment, charge entry, claim scrubbing, electronic claim submission, payment posting, denial management, A/R follow-up, patient statements, coding audits and monthly reporting.

How much do medical billing and coding services cost?

VisMed’s medical billing fees are a percentage of what we collect, with no setup fee, no minimum and no per-claim charge. If we collect nothing, you pay nothing. Coding-only or project work, such as an A/R clean-up, is quoted separately before it starts.

Do you provide medical billing and coding services separately?

Yes. Most providers use VisMed for both, because that is where denials drop fastest, but we also provide outsourced medical coding services on their own for practices with an in-house biller, and billing on its own for practices with their own coders.

Are your medical coders certified?

Yes. VisMed’s coders hold CPC credentials from AAPC or CCS credentials from AHIMA, and they are assigned by specialty, so your claims are coded by someone who works your specialty every day.

Which specialties do you provide billing and coding for?

VisMed provides billing and coding for more than 50 specialties, including primary care, internal medicine, cardiology, orthopedics, behavioral health, physical therapy, clinical laboratory, urgent care and ambulatory surgery centers.

Can you work with my current EHR or practice management system?

Yes. VisMed works inside the system you already use, including athenahealth, eClinicalWorks, Epic, NextGen, AdvancedMD, Tebra, ModMed, WebPT and SimplePractice. There is no migration, and your data stays in your system.

How do you reduce claim denials caused by coding errors?

VisMed codes from the note with specialty-matched certified coders, scrubs every claim against NCCI edits, medical necessity rules and payer policies before submission, audits samples of coded encounters, and sends every coding denial back to the coder so its cause is fixed.

Do you bill Medicare, Medicaid, and commercial insurance?

Yes. VisMed bills Medicare and Medicare Advantage, Medicaid and Medicaid managed care plans in every state, commercial payers including UnitedHealthcare, Blue Cross Blue Shield, Aetna, Cigna and Humana, plus TRICARE, VA Community Care, workers’ compensation and personal injury claims.

How quickly can you take over billing from our current team or company?

When you switch medical billing company, most handovers take a few weeks, mostly spent on system access, payer remittance routing and loading your fee schedules. VisMed takes over open A/R and aging denials as well as new claims, and plans the cutover so no claim is lost between your current team or company and us.

Why outsource medical billing and coding instead of keeping it in-house?

Outsourced medical billing services give you certified coders, experienced billers and denial specialists without hiring them, covers vacations and turnover, and ties the cost to what is collected. With VisMed the work still happens in your own system, so you keep full visibility and control.