Medical Billing Services in Vermont

Vermont is the exception that proves how much multi-plan states cost practices. There are no risk-bearing commercial managed care organizations in its Medicaid program. One public agency administers coverage under one set of rules, which sounds simpler, and in one sense it is. But it concentrates all the pressure on getting that single program’s documentation and prior authorization requirements exactly right, because there is no second plan to fall back on when a claim is built wrong.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Vermont practices of every specialty, built around the state’s actual payers and programs.

Vermont’s payer landscape

Vermont Medicaid runs under Green Mountain Care, administered by the Department of Vermont Health Access (DVHA) under a public managed care model. DVHA is the state’s only managed care entity for Medicaid, contracting with providers and paying claims directly rather than handing risk to commercial plans. For billing, that means one rulebook, one authorization process, and one fee schedule to master, and no plan-shopping when a claim denies.
Commercial coverage is narrow by national standards. Only two carriers sell plans on Vermont Health Connect: Blue Cross and Blue Shield of Vermont and MVP Health Care. The same two carriers anchor the small group market. Medicare Part B claims run through National Government Services, Jurisdiction K, and Medicare Advantage plans add their own prior authorization rules on top of the Medicaid and commercial mix.

What MedPlus RCM handles for Vermont 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 Vermont Medicaid (DVHA), commercial payers, and Medicare, 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 practices statewide, Burlington, South Burlington, Rutland, Barre, Montpelier, and Essex, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.

Results Vermont 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

How is Vermont Medicaid different from other states?
Vermont has no risk-bearing commercial Medicaid plans. DVHA administers Green Mountain Care directly, so there is one rulebook and one authorization process, and accuracy on the first submission matters more than plan selection.
Do you work with DVHA?
Yes. We bill Vermont Medicaid through DVHA, as well as Blue Cross and Blue Shield of Vermont, MVP Health Care, and Medicare plans.
Who are Vermont’s commercial carriers?
Blue Cross and Blue Shield of Vermont and MVP Health Care are the two carriers on Vermont Health Connect and in the small group market.
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 Vermont practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
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