Services
Medical billing and coding that gets claims paid the first time
We code every encounter to your specialty, scrub each claim against payer rules and submit within one business day, so revenue arrives on schedule instead of in rework.
| Code | What it means |
|---|---|
CARCCO-16 | Claim lacks information or has submission errors |
CARCCO-4 | Procedure code inconsistent with modifier, or modifier missing |
CARCCO-97 | Service included in another service already paid |
CARCCO-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 missing modifier, a diagnosis coded one level too vague, or a registration field nobody checked. Medwiser’s coders and billers work inside your systems every day, coding from your documentation and checking each claim before it is submitted.
You keep full visibility. Every claim, remit and adjustment stays in your practice management system, and your account manager walks you through the numbers each month.
What's included
- Charge entry and codingCPT, HCPCS and ICD-10-CM codes assigned from your documentation, with modifiers checked against National Correct Coding Initiative (NCCI) edits.
- Claim scrubbingEvery claim is checked for payer-specific rules, missing fields and eligibility before it leaves your clearinghouse.
- Electronic submissionClean claims submitted within one business day of charge entry, with clearinghouse rejections worked the same day.
- Payment postingElectronic remittance advice (ERA) and paper EOBs posted line by line, so underpayments and denials surface immediately.
- Patient statementsClear statements and a US-based number for patient billing questions, if you want us to handle them.
- Monthly reportingCollections, clean claim rate, denials and A/R by payer, walked through with your account manager.
Where revenue leaks
The problems we fix
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 fix the claim and the intake step that caused it.
CARCCO-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. Our coders check modifiers before submission, not after the denial.
CARCCO-4Procedure code inconsistent with modifier, or modifier missingCARCCO-97Service included in another service already paid
Diagnosis codes that don't support the procedure
When the ICD-10 code doesn't establish medical necessity for the CPT code, payers deny. We code to the highest supported specificity from your note.
CARCCO-11Diagnosis inconsistent with the procedure
How it works
Getting started with medical billing
Coding and billing review
We audit a sample of recent claims and remits under a signed BAA to find coding gaps and rejection patterns.
System access and payer setup
We connect to your EHR, practice management system and clearinghouse, and confirm payer enrollment and ERA setup.
Go live
Daily charge entry, coding and submission begin, with a parallel check against your current process.
Report and refine
We review clean claim rate, denials and collections with you and fix root causes upstream.
Benchmarks
The numbers we report against
Industry benchmarks and our own service targets. We measure your baseline in a free review and report against it every month.
FAQ
Medical Billing & Coding: common questions
Do your coders 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. Nothing needs to be exported or re-keyed.
Which specialties do you code for?
Primary care, internal medicine, pediatrics, cardiology, orthopedics, behavioral health, physical therapy and urgent care, among others. Tell us your specialty and we will confirm coder experience before you sign.
How are billing and coding services priced?
Most practices pay a percentage of collections, so our fee rises and falls with what you are actually paid. 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. Claims submitted before it stay with your current process or move to our A/R team; everything after it is ours from charge entry onward.
Related services
Often paired with
Denial Management
Denials appealed fast and prevented from happening again.
- Every denial coded to its CARC reason
- Appeals with the right documentation
- Root-cause fixes upstream
A/R Recovery
Old balances followed up until they are paid or properly closed.
- Oldest balances worked first
- Payer follow-up by phone and portal
- Weekly aging report
Prior Authorization
Authorizations requested, tracked and approved before the patient arrives.
- Requirements checked at scheduling
- Requests submitted with clinicals
- Status tracked to a decision
Free coding review
See how many of your claims are paid first time
Send us a few details and we will review a sample of recent claims and show you where coding and scrubbing would change the result.