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Billmax MD — The future of medical billing
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Services

The complete revenue cycle, handled

Nine disciplines that decide whether a practice gets paid properly. Engage all of them or start with the one that is hurting most — each is built to stand alone.

The Billmax MD operations floor, where claims are coded, scrubbed and submitted daily
A Billmax MD credentialing specialist organising provider licences and enrollment files
01

Credentialing & Enrollment

Payer enrollment, CAQH upkeep and re-credentialing handled end to end, so a new provider starts billing in weeks instead of months.

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  • Initial payer applications and contract negotiation support
  • CAQH profile build, maintenance and re-attestation
  • Medicare PECOS and Medicaid state portal enrollment
  • Re-credentialing calendar with lapse alerts
  • Group and individual NPI management
  • Hospital privileging paperwork support
A certified medical coder checking a code reference beside his dual-monitor workstation
02

Medical Coding

Certified coders assign ICD-10-CM, CPT and HCPCS codes to the documentation — catching specificity gaps before they become denials.

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  • ICD-10-CM, CPT and HCPCS Level II assignment
  • Modifier application and NCCI edit checking
  • E/M level review against 2021+ AMA guidelines
  • Specialty-specific coding for surgery and procedures
  • Provider documentation queries where notes fall short
  • Monthly coding audit sample with feedback to providers
A billing specialist entering charges from a superbill into the practice management system
03

Charge Entry

Demographics, insurance and charges keyed accurately into your PM system with same-day turnaround and a second-pass review.

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  • Patient demographic and insurance data entry
  • Charge capture from encounter forms and EHR
  • Place-of-service and modifier verification
  • Fee schedule application and validation
  • Duplicate charge detection
  • Missing-charge reconciliation against the schedule
A claims reviewer pointing out a flagged line during a pre-submission check
04

Claim Scrubbing

Every claim runs through payer-specific edits and a human review pass before submission, targeting a first-pass acceptance rate above 95%.

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  • Real-time eligibility and benefits verification
  • NCCI and MUE conflict detection
  • Modifier logic and bundling review
  • Demographic and policy-number validation
  • Prior-authorisation presence checks
  • Payer-specific formatting and field requirements
A billing specialist smiling after a batch of claims is accepted for submission
05

Claim Submission

Electronic submission to every payer with acknowledgement tracking — so a claim that silently fails at the clearinghouse never goes unnoticed.

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  • Daily electronic claim submission (837P / 837I)
  • Paper claim submission where a payer requires it
  • Clearinghouse acknowledgement (277CA) reconciliation
  • Rejection triage and same-day resubmission
  • Secondary and tertiary claim generation
  • Corrected claim and void/replacement handling
A payment posting specialist reconciling remittance statements with a calculator
06

Payment Posting & Reconciliation

ERA and EOB posting with line-level reconciliation against your contracted rates — so underpayments surface instead of settling silently.

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  • ERA (835) auto-posting with exception review
  • Manual EOB and correspondence posting
  • Patient payment and card-on-file posting
  • Contractual adjustment verification
  • Underpayment identification against fee schedules
  • Bank deposit to posting reconciliation
Two Billmax MD specialists reviewing a denied claim before drafting the appeal
07

Denial Management & Appeals

Every denial is worked, categorised and appealed with payer-specific documentation — and the root cause is fixed so it does not repeat.

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  • CARC / RARC denial categorisation and trending
  • First-level and second-level appeal drafting
  • Peer-to-peer and medical-necessity appeal support
  • Payer policy and LCD citation in appeal letters
  • Corrected claim resubmission where appeal is not required
  • External review and state escalation where warranted
A team lead walking colleagues through an accounts receivable aging chart
08

Accounts Receivable Management

Systematic AR follow-up by aging bucket and payer, with the goal of pulling your 90+ day receivables down and keeping them there.

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  • Aging analysis by payer, provider and bucket
  • Systematic payer follow-up calls with reference numbers
  • Stalled and no-response claim escalation
  • Timely-filing risk queue worked first
  • Small-balance and write-off policy recommendations
  • Patient balance follow-up and statement cycles
A patient scheduling agent in a headset speaking warmly with a patient
09

Patient Scheduling & Front Office

Empathetic patient communication, appointment setting and eligibility verification before the visit — so billing problems never start.

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  • Inbound appointment calls and scheduling
  • Appointment reminder and confirmation calls
  • Insurance eligibility and benefits verification
  • Prior-authorisation initiation and tracking
  • Referral coordination and tracking
  • No-show follow-up and rebooking

Specialty billing

Built for the practices that are hardest to bill

Heart surgery practices

Cardiac Surgery Billing

Billing for heart surgery and cardiothoracic practices — global periods, co-surgeon and assistant claims, and the modifier logic that decides whether a high-value case is paid in full.

  • CABG, valve and aortic procedure coding from the operative report
  • Global surgical period tracking with pre- and post-operative visit rules
  • Co-surgeon (-62) and assistant-at-surgery (-80, -82, -AS) claim coordination
  • Decision-for-surgery (-57) and unrelated post-op visit (-24) modifiers
  • Unplanned return to the operating room (-78) and unrelated procedures (-79)
View cardiac surgery billing
A cardiothoracic surgeon reviewing an operative summary with a Billmax MD billing liaison
Engagement

You do not have to hand over everything at once

Many practices start with denials and AR only, prove the result, then expand. The onboarding path is the same either way.

01

Discovery & audit

We review a sample of your recent claims, denials and aging report to find where revenue is actually leaking. You get the findings whether or not you engage us.

02

Onboarding

BAA signed, system access provisioned, fee schedules and payer contracts loaded. Your dedicated team is introduced by name.

03

Parallel run

We run alongside your current process for the first cycle so nothing drops during the transition and you can compare results directly.

04

Full operation

We take the cycle end to end — scheduling through AR — with weekly movement reporting and a monthly review call.

05

Continuous improvement

Denial patterns feed back into coding and front-desk workflow every month. The goal is a shrinking problem list, not a stable one.

Find out what your revenue cycle is leaking

Send us a recent aging report and a sample of denials. We will tell you where the money is going — no obligation.

Book a free audit+1 (904) 250-0958
A physician in an unhurried conversation with a patient