Medicare Billing, Done Right the First Time

Medicare is the largest single payer for most practices that serve patients over 65 — and one of the strictest. Claims must match Medicare’s coverage rules, coding edits, and documentation requirements exactly, or they come back denied. MedPlus RCM manages Medicare billing end to end so your practice is paid correctly, and paid on time.

What MedPlus RCM Handles for Medicare

Eligibility and enrollment verification. Before the visit, we verify the patient’s Medicare eligibility and enrollment status, so claims are not filed to the wrong plan or for a patient whose coverage has changed.

Clean claim submission. Claims are coded by certified coders and checked against Medicare’s edits before submission, keeping first-pass acceptance high. Practices working with MedPlus RCM report a 99% clean claim rate.

Medical necessity and documentation. Medicare denies claims that do not demonstrate medical necessity. We flag documentation gaps before submission — missing diagnoses, unsupported procedures, and incomplete orders — so they are fixed while the claim can still be corrected.

Denial management and appeals. When Medicare denies a claim, we identify the reason, correct it, and resubmit or appeal within Medicare’s deadlines. Repeat denial patterns are fixed at the source so the same claims stop coming back.

Secondary and supplemental claims. When a patient carries supplemental coverage, we coordinate the crossover and secondary claim so the remaining balance is pursued rather than written off.

Timely filing discipline. Medicare claims must be filed within 12 months of the date of service. Our workflow tracks filing deadlines so no claim ages out unpaid.

Payment posting and reconciliation. Payments, adjustments, and patient responsibility amounts are posted and reconciled against what was billed, so underpayments surface instead of disappearing.

Common Medicare Denials We Prevent

  • Claims filed after the timely filing window
  • Missing or invalid diagnosis codes that fail medical necessity checks
  • Services billed without the required supporting documentation
  • Duplicate claims and coding edits that trigger automatic rejections
  • Eligibility mismatches — coverage ended, wrong Medicare plan, or missing enrollment

Why Practices Trust MedPlus RCM with Medicare

Medicare billing rewards precision and punishes sloppiness. MedPlus RCM combines certified coders, denial recovery, and real-time financial analytics so you can see exactly how your Medicare revenue is performing — clean claim rate, denial rate, days in A/R, and collections — at any time. Practices working with MedPlus RCM run accounts receivable under 30 days, and onboarding typically takes 2–4 weeks. MedPlus RCM is 100% HIPAA compliant.

Get a Free Audit of Your Medicare Revenue

If Medicare denials or slow payments are eating into your revenue, the free financial audit will show you where. Request your free audit today and see what your Medicare billing should be recovering.