Medical Billing Services
Medical Billing Services for US Practices
End-to-end billing built around one outcome: claims that go out clean, payments that post on time, and an A/R report you are not afraid to open. We handle charge entry through denial resolution inside the system you already use.
HIPAA-compliant workflowsAAPC / AHIMA-certified codersWorks in your EHR / PMUS-based account leads
Service overview
What medical billing actually covers
Medical billing is the work that turns a completed patient encounter into collected revenue. It starts with capturing charges accurately, continues through claim preparation and submission, and does not end until the payer has paid correctly or the balance has been resolved.
Most practices do not lose revenue because of one broken step. They lose it because the steps are handled by whoever has time that day. Claimstone takes ownership of the full cycle, assigns named specialists to your account, and documents every action.
Complete service breakdown
Eight components, each with a job to do
What each part of the service does - and why it matters to your collections.
Charge Entry
Every rendered service is entered against the correct provider, place of service, and date - pulled from your documentation, not guessed from a superbill.
Why it matters. Missed charges never become claims, and no amount of follow-up recovers revenue that was never billed.Claim Preparation & Submission
Claims are scrubbed against payer-specific edits, modifiers and diagnosis links are verified, then filed electronically with clearinghouse rejections worked same-day.
Why it matters. A clean first submission is the cheapest payment you will ever collect.Payment Posting
ERAs and paper EOBs are posted line by line, with contractual adjustments, underpayments, and patient responsibility reconciled against your fee schedule.
Why it matters. If posting is sloppy, every report downstream is wrong and underpayments go unnoticed.Denial Management
Denials are categorised by reason code, corrected or appealed with supporting documentation, and traced back to the upstream cause.
Why it matters. Unworked denials are the single largest source of quietly abandoned revenue.AR Follow-Up
Open insurance and patient balances are segmented by age, payer, and dollar value, then worked on a documented schedule.
Why it matters. Aged AR gets attention based on recoverability, not whoever happens to have time.Insurance Eligibility & Verification
Coverage, benefits, authorisations, and referral requirements are checked before the patient is seen.
Why it matters. Problems found before the visit are fixable. Problems found after it become write-offs.Patient Billing
Statements, balance questions, payment plans, and billing calls are handled in plain language that reflects your policies.
Why it matters. Your front desk gets back to patients instead of explaining EOBs all afternoon.Billing Reports & Visibility
Recurring reports show claims, payments, aging, denials, collection activity, and payer trends in numbers your team can use.
Why it matters. You see what was submitted, what was paid, what is open, and what happens next.Problems -> solutions
Start with what is going wrong
Practices rarely call asking for billing services. They call because one of these has become unmanageable.
Problem 01Unpaid claims+
Claimstone solution
Claim status tracking with owned follow-up. Every submitted claim is tracked to an outcome.
Problem 02Frequent denials+
Claimstone solution
Denial management with root-cause correction. The upstream cause is fixed, not just the current denial.
Problem 03Growing AR+
Claimstone solution
AR follow-up prioritised by recoverability, age, payer, and dollar value.
Problem 04Billing backlogs+
Claimstone solution
Backlog clearing alongside current-day billing so nothing new waits.
Problem 05Eligibility issues+
Claimstone solution
Verification moved upstream of the encounter before the appointment.
Problem 06Limited reporting+
Claimstone solution
Recurring reporting that makes claims, payments, aging, and denials visible.
End-to-end workflow
One continuous process, from encounter to resolved balance
Billing fails at the handoffs. When one team owns all eight stages, there are no handoffs to lose work in.
STAGE 01Patient Encounter
Eligibility and authorisation confirmed before the visit is documented.
STAGE 02Charge Capture
Services entered against the right provider, date, and place of service.
STAGE 03Claim Preparation
Coding reviewed, modifiers checked, payer edits applied before filing.
STAGE 04Claim Submission
Electronic filing with clearinghouse rejections worked the same day.
STAGE 05Payer Response
Acceptances, denials, and requests for information triaged on arrival.
STAGE 06Payment Posting
ERAs and EOBs posted line by line and reconciled to your fee schedule.
STAGE 07Denial Resolution
Corrected, appealed, and traced back to the cause so it stops repeating.
STAGE 08AR Follow-Up
Open balances worked to resolution - paid, adjusted, or escalated to you.
How Claimstone works
What happens after you contact us
Five steps. No software to buy, no data migration, and no pause in claim submission while we take over.
Understand the practice
We review your specialty, payer mix, volume, software, and current aging before proposing anything.
Build the billing workflow
Coding conventions, submission schedule, escalation rules, and reporting cadence are documented in writing.
Manage claims
Charges are entered, claims scrubbed and submitted on a fixed schedule, and rejections handled before they age.
Work payments, denials & AR
Posting, reconciliation, appeals, and follow-up run continuously with a note on every account.
Report & improve
Recurring reporting and a standing review turn recurring denial patterns into process changes.
Benefits of outsourcing
What changes when billing is not your problem anymore
Your staff stop splitting attention between patients and payer phone trees.
Claims go out and get worked on a schedule that does not move for turnover or busy weeks.
Aged balances are triaged and worked deliberately instead of written off.
Recurring reporting replaces the quarterly scramble to find where the money is.
Adding a provider, location, or service line does not require hiring another biller first.
Who we serve
Scaled to your size, not ours
We take on full-cycle billing and targeted engagements alike. The difference between a solo practice and a multi-site group is scope, not standard of work.
Solo & small practices
Full billing coverage without hiring in-house, and without billing stopping when one person is out.
Group practices
Provider-level reporting, consistent coding across the group, and one point of contact.
Specialty practices
Coding and authorisation handling built around your specialty rules.
Clinics & healthcare organisations
Multi-location volume, split payer contracts, and reporting by site and service line.
New & expanding practices
Billing, credentialing, and payer enrollment set up together.
Denial practices
Denial claim formats, attachments, and plan maximums tracked with discipline.
Specialty relevance
Billing requirements vary by specialty
Documentation standards, authorisation rules, and denial patterns differ. So does the way we work your claims.
Primary CareHigh volume, wellness visitsDiscuss your workflow ->Behavioral HealthTime-based codes, auth trackingDiscuss your workflow ->CardiologyDiagnostics, modifier accuracyDiscuss your workflow ->OrthopedicsGlobal periods, surgical bundlingDiscuss your workflow ->DermatologyCosmetic vs. medical necessityDiscuss your workflow ->Urgent CareWalk-in volume, POS codingDiscuss your workflow ->TelehealthPlace-of-service, payer parityDiscuss your workflow ->
Reporting & revenue visibility
The eight things you should be able to see at any time
Each view comes with the Claimstone benchmark we hold ourselves to.
Volume submitted, accepted, rejected, and pending by period.
98%First-pass claim acceptancePosted receipts by payer, provider, and location.
24 hrsERA to posted paymentTotal outstanding, split between insurance and patient balances.
26 daysAverage days in A/RBalances by bucket, so the over-90 trend is visible early.
< 12%A/R over 90 daysReason codes ranked by dollars at risk, with appeal status.
72%Denial recovery rateCompliance & security
Patient and financial data, handled deliberately
Outsourcing billing means giving another organisation access to PHI. We treat that as the most consequential part of the engagement, and review our controls with you during onboarding.
HIPAASIGNED BAANAMED-USER ACCESS
A signed BAA is in place before anyone on our team is given access to your system.
Named accounts only, scoped to the role, revoked when a specialist rolls off.
Patient data stays inside your EHR or PM, not personal devices or unencrypted email.
Claim-level notes record who did what and when.
FAQs
Questions we get before the first call
If yours is not here, ask it on the assessment call. We would rather answer it before you sign anything.
What do medical billing services include?+
Charge entry, claim preparation and submission, payment posting, denial management, AR follow-up, insurance eligibility and verification, patient billing, and recurring billing reports.
Why do practices outsource billing?+
Usually because billing has become dependent on one or two people, follow-up slips when the clinic gets busy, and nobody has time to work aged claims.
What does a medical billing company actually do day to day?+
Enters charges, scrubs and submits claims, posts payments, works rejections and denials, calls payers on open balances, sends patient statements, and reports on all of it.
How do you handle denials?+
Denials are grouped by reason code, corrected or appealed with supporting documentation, and tracked to an outcome.
Do you work with our existing software?+
Yes. We work inside your current EHR or practice management system under named user accounts. There is nothing to buy and no data migration.
How long does the transition take?+
Most practices are fully transitioned within 30 days: paperwork and access first, a baseline audit, then a parallel run alongside your team.
Free billing assessment
Find out what your billing is leaving behind.
A 30-minute review of your aging, denial history, and current workflow with a billing specialist. You get a written summary of what we found, whether or not you work with us.
- No obligation and no PHI required to get started
- Specific findings on your payer mix, not a generic pitch
- If billing is not your bottleneck, we will tell you that