Services

Medical billing built on clean, documented claims

We review patient demographics and eligibility, enter charges daily, support coding from your provider documentation and submit claims electronically, then manage clearinghouse rejections and secondary payers.

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Common codes in this work4 codes

Code	What it means
`CARC CO-16`	Claim lacks information or has submission errors
`CARC CO-4`	Procedure code inconsistent with modifier, or modifier missing
`CARC CO-97`	Service included in another service already paid
`CARC CO-11`	Diagnosis inconsistent with the procedure

CARC = claim adjustment reason code, as printed on your remittance.

Billing problems rarely start at the payer. They start with a registration field nobody checked, a missing modifier, or documentation that doesn’t support the code. Medwiser’s trained medical coding and billing specialists work inside your systems, supporting coding from your documentation and reviewing claim details before submission.

You keep full visibility. Every claim, remit and adjustment stays in your practice management system.

What's included

Patient Demographic & Eligibility ReviewPatient demographics and insurance eligibility are reviewed, so claims start from accurate registration data.
Daily Charge EntryCharges are entered each business day from the information your practice provides.
Coding Support (ICD-10-CM / CPT / HCPCS)Code assignment support that adheres strictly to provider documentation.
Electronic Claim SubmissionClaims are submitted electronically through your clearinghouse.
Clearinghouse Rejection ManagementClearinghouse rejections are reviewed, corrected and resubmitted.
Secondary Payer CoordinationSecondary claims are coordinated once the primary payer responds, so balances reach the right payer.

Where revenue leaks

The problems we work on

Claims rejected for missing or invalid information
Front-end rejections and CO-16 denials usually trace back to registration data or a missing field. We correct the claim and flag the intake step behind it.
- CARC CO-16Claim lacks information or has submission errors
Modifier and bundling denials
A missing modifier 25 on a same-day E/M visit or an NCCI bundling edit can zero out a line. Modifiers are reviewed against provider documentation before submission.
- CARC CO-4Procedure code inconsistent with modifier, or modifier missing
- CARC CO-97Service included in another service already paid
Diagnosis codes that don't support the procedure
When the ICD-10-CM code doesn't establish medical necessity for the CPT code, payers deny. Coding support follows what your provider documented, and gaps are raised with your team rather than assumed.
- CARC CO-11Diagnosis inconsistent with the procedure

How it works

Getting started with medical billing

Step 1
Billing assessment
Standard BAA executed prior to system access. We then review a sample of recent claims and remits to find rejection patterns and documentation gaps.
Step 2
System access and payer setup
We connect to your EHR, practice management system and clearinghouse, and confirm payer details.
Step 3
Go live
Daily charge entry and electronic claim submission begin on a start date we agree with you.
Step 4
Review and refine
Rejection patterns are reviewed with your team, so their causes can be addressed upstream.

Benchmarks

Benchmarks to measure against

Common industry benchmarks and, where noted, our service targets. We can measure your baseline in a free review.

≥95%

Clean claim rate

Common industry benchmark for claims accepted on first submission

≤35days

Days in A/R

Common industry target for a healthy practice

FAQ

Medical Billing: common questions

Does your team work in our EHR, or do we export data to you?

We work inside your existing EHR and practice management system with role-based accounts you control.

Do you assign codes without provider documentation?

No. Coding support adheres strictly to provider documentation. Where documentation is unclear, we raise it with your team.

Which specialties do you support?

Primary care, internal medicine, pediatrics, cardiology, orthopedics, behavioral health, physical therapy and urgent care, among others. Tell us your specialty and we will confirm our experience with it before you sign.

How is medical billing priced?

Pricing is usually a percentage of collections. We confirm the rate after reviewing your claim volume and payer mix.

What happens to claims already in progress when we switch?

We agree a cut-over date with you. Claims submitted before it stay with your current process unless we agree otherwise.