Family Medicine Billing Services

Family medicine is the broadest billing specialty in the practice, and that breadth is exactly what makes it hard to bill well. One schedule can hold a newborn check, a Medicare wellness visit, a same-day sick visit, a chronic disease follow-up, and a minor procedure, and each of those encounters follows different coding rules. A billing workflow built for a single service type will undercode some visits, overcode others, and lose revenue in both directions.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for family medicine practices, built around the realities of a full-scope primary care schedule.

Family medicine billing challenges

The most common family medicine billing problem is the mixed visit. A patient comes in for a preventive exam and raises a separate acute problem, or a chronic disease visit turns into a procedure. When a significant, separately identifiable problem is addressed during a preventive visit, both services can be reported, but only with modifier 25 on the problem-oriented visit and documentation that supports both. Without that separation, payers bundle the visit or deny it outright.
Chronic care management is the second revenue leak. Medicare’s chronic care management benefit covers non-face-to-face care coordination for patients with two or more chronic conditions, billed monthly in time-based tiers. It requires a qualifying initiating visit, documented patient consent, and a comprehensive care plan, and only one practitioner may bill it for a patient in a given month. Practices that do the coordination work but skip the enrollment steps leave that revenue unclaimed.
Preventive care adds its own layer. Annual wellness visits, immunizations, and screenings each carry age, frequency, and diagnosis rules, and vaccine claims require both a product code and an administration code. Getting any one element wrong turns a covered preventive service into a denial.

What MedPlus RCM handles for family medicine practices

• End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
• Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
• Provider credentialing and enrollment. End-to-end enrollment with commercial payers, Medicare, and Medicaid, plus re-credentialing maintenance.
• Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
• A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
• Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
  We serve family medicine practices of every size, from solo clinics to multi-provider groups, across all 50 states.

Results family medicine practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Can a preventive visit and a sick visit be billed on the same day?
Yes, when the problem addressed is significant and separately identifiable from the preventive service. The problem-oriented visit is reported with modifier 25, and the note must document both services distinctly.
What does chronic care management billing require?
A qualifying initiating visit, documented patient consent, a comprehensive care plan, and at least 20 minutes of qualifying care coordination time in the calendar month. Only one practitioner may bill chronic care management for a patient in a given month.
Do you handle Medicare Annual Wellness Visits?
Yes. We bill initial and subsequent annual wellness visits, including the health risk assessment and personalized prevention plan elements, and we track the once-per-12-months frequency rule.
How do vaccine claims work in family medicine?
Each immunization needs a product code and an administration code, and the administration code family depends on patient age and whether counseling was provided. We match both elements to the documented encounter.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your family medicine practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
Request your free financial audit