Physician Group Medical Billing Services | 20+ Provider Practices
At 20 providers, spreadsheets break. At 50, your billing company breaks.
The RCM stack that worked at 8 providers does not work at 30. The billing company that ran charge entry clean at 15 now loses eight payer panels mid-credentialing because nobody owns the tracker. Your CFO is reconciling per-provider collections in Excel on a Sunday. Your CEO is explaining to a cardiologist why her wRVUs don’t match her comp.
A scale problem dressed as a billing problem.
Revenant Care runs billing, coding, credentialing, and denial operations for multi-specialty and single-specialty groups between 20 and 150 providers. US account management. Offshore production at scale. Pricing you can compare line-by-line against your in-house cost.
Request a per-provider TCO analysis
Multi-provider operational complexity is where groups leak revenue
Past 20 providers, operational load stops being linear. Every new hire adds a credentialing cycle, an NPI/PECOS file, a CAQH attestation schedule, a payer panel roster, and a comp formula that has to reconcile against charge capture. Miss any one and the provider either cannot bill or bills under the wrong TIN.
What we own for groups this size:
- Credentialing cycles. Initial enrollment, re-credentialing every 24-36 months, delegated credentialing where you have it.
- NPI/PECOS maintenance. Type 1 and Type 2 reconciliation. PECOS updates when providers move, change DEA, or exit.
- Payer panel tracking. Who is in-network with which payers, by product line, by state. A live roster, not a quarterly spreadsheet.
- Group-versus-individual billing. Group TIN with rendering provider NPI, correctly. Resolving payer edits that want solo enrollment instead of group assignment.
- Locum tenens handling. Q6 modifier rules, 60-day reciprocal arrangements, documentation trail so you are not back-billing or refunding nine months later.
When credentialing runs as a side task, groups lose 3-6% of gross revenue to lag alone. Recoverable.
See: Physician Credentialing Services
MIPS, MVPs, and APM reporting: what we do, what you keep
Quality reporting is not optional at your size. Failing to report carries a 9% Medicare penalty on every claim for the payment year.
Clinicians own the data. We run the submission machinery.
| Category | Revenant Care does | Practice keeps |
|---|---|---|
| Quality (30%) | Measure spec, EHR data extraction, registry/claims submission, decile benchmarking | Measure selection, clinical documentation |
| Promoting Interoperability (25%) | Attestation packaging, SAFER guide docs, audit-ready support files | Security risk analysis, EHR configuration |
| Improvement Activities (15%) | Activity documentation, attestation language, 90-day verification trail | Choosing and running activities |
| Cost (30%) | Pre-submission forecast so you know exposure before the year closes | Care decisions that drive cost |
For MVPs, we build the specialty measure set once and re-use it. For APMs, we coordinate with your ACO or CIN on the data feed and make sure the attribution file matches your claims file.
E&M coding and audit defense under the 2021 guidelines
The 2021 revisions replaced history and exam counts with MDM or total time. Four years in, audit risk has not gone down. It has moved.
What we audit on 99202-99215:
- MDM versus time selection. Documentation has to support one. Picking the higher without support is the cleanest way to earn a post-payment review.
- Problem count, data, and risk. “Stable chronic” and “undiagnosed new problem with uncertain prognosis” are not the same box.
- Modifier 25 on same-day procedures. Billable when separately identifiable. Billing it every time is a flag. We audit 25-rates by provider and coach anyone sitting more than 2 standard deviations above specialty peers.
- Time-based documentation. Start time, stop time, activities. Not “spent 40 minutes with patient.”
Post-payment audit support is included. When a TPE or UPIC letter arrives, we pull records, assemble the response packet, and write the medical necessity narrative with provider sign-off. Groups at your size see 2-6 audit letters per year. Losing one on a recurring E&M pattern runs six figures in extrapolated recoupment.
See: Medical Coding
Credentialing as a distinct line, not a side task
Billing failures show up as denials. Credentialing failures show up as unbillable providers. Different problem, different team.
- Initial enrollment with Medicare, state Medicaid, commercial payers, and delegated entities. Turnaround 60-120 days.
- Re-credentialing on 24 or 36-month cycles. We start 120 days before the deadline.
- CAQH maintenance. Quarterly attestation, document refresh, committee updates. A lapsed CAQH blocks every commercial re-credential downstream.
- Payer contract re-negotiations. At 20+ providers you have leverage most solo practices do not. We prep the rate comparison, market data, and specialty-benchmarked fee schedule so your CFO walks in with numbers.
See: Physician Credentialing Services
Specialty depth across the mix most multi-specialty groups run
Coders who run primary care cannot run cardiology. We staff by specialty pod, not generalist pool.
- Primary care / internal medicine. AWV vs. IPPE, CCM 99490, TCM 99495-99496, screenings bundled correctly.
- Cardiology. Echo 26/TC split, stress test global vs. split, device interrogations 93293-93296, ICD-10 laterality on vascular.
- Orthopedics. 90-day global management, modifier 58/78/79, fracture care vs. E&M election, DME HCPCS.
- GI. Screening vs. diagnostic colonoscopy payer rules, modifier 33 and PT, anesthesia coordination.
- Dermatology. Lesion measurement pre/post excision, Mohs staging 17311-17315, biopsy bundling edits.
- Rheumatology. Infusion coding 96365-96375 sequencing, J-code units, buy-and-bill reconciliation, prior-auth renewals.
- Urology. Cystoscopy modifier rules, prostate procedures, in-office lab and pathology components.
- OB/GYN. Global maternity 59400/59510/59610 vs. unbundled delivery, antepartum/postpartum splits, well-woman bundling.
Every specialty gets a named coder and a QA pass from a second coder before claim release.
Denial management at scale: root-cause across 20+ providers
One denial is a ticket. 4,000 denials a month is a pattern.
At your volume, value is not working each denial. It is seeing the pattern across providers, payers, and specialties, and fixing it at the source. We batch-classify every denial by CARC/RARC, provider, payer, and service line, weekly. Output is a one-page root-cause brief your CFO or COO reviews Monday morning.
Typical patterns in the first 60 days:
- One provider generates 40% of modifier-25 denials because of a documentation habit, not a coding error.
- Two payers drive 60% of medical necessity denials on the same three CPT codes — an LCD update nobody flagged.
- A credentialing gap is triggering 18% of a provider’s denials. Fix is enrollment, not billing.
Benchmarks for well-run groups at this size: first-pass resolution 90-95%, net collection rate 95-97% on a 12-month look-back, days in A/R 32-45, denial rate on charge under 7%. Outside those bands, the gap is operational, not software.
Revenue reporting a CFO actually uses
Stock reports out of athenahealth or AdvancedMD tell you what was billed and paid. They do not tell you which providers are profitable, which contracts are underpaying, or where RVU-based comp is drifting against collections.
Monthly deliverables:
- Per-provider profitability. Collections minus direct cost (comp, benefits, malpractice, allocated overhead). Ranked.
- Per-payer net collection rate. Contracted rate versus actual paid, by payer, by CPT band. Flags underpayment before it compounds.
- wRVU tracking. Reconciled against the comp formula. Variance report for any provider drifting more than 10% off specialty benchmark.
- A/R aging by provider and payer. A named owner for every bucket over 60 days.
- MIPS / MVP interim scorecard. Quarterly, so a bad trajectory is caught in Q2, not at submission.
Pricing: per-provider versus percent of collections
Both models exist. The honest ranges:
- Percent of collections: 4-7% of net collections for 20-150 provider groups. Lower end for high-volume primary care with clean payer mix. Higher end for specialty groups with infusion, surgical, or high-denial exposure.
- Per-provider flat fee: $1,200-$2,000 per provider per month for offshore production with US account management. Varies with volume, specialties, and scope.
- Hybrid: Base per-provider fee plus a performance-linked component on net collections above a contractual floor. Often the right structure for groups coming off a bad prior vendor.
Our quote is a side-by-side against your current all-in: biller comp, coder comp, credentialing coordinator, software, clearinghouse, reporting tools, A/R lag cost. If we cannot beat your all-in on a 24-month projection, we tell you.
Why Revenant Care, specifically
Most offshore RCM vendors sell labor arbitrage. Not enough at your scale.
- Dedicated US account manager. One person. Named. Your CFO’s cell and your COO’s standing weekly. Not a ticket queue.
- Offshore production at scale. Coders, billers, A/R callers, credentialing specialists, denial analysts. Organized by specialty pod, not general pool.
- ABA and behavioral-health cross-training. If your group is an integrated primary care plus BH platform, we run the BH book on the same account. Most competitors cannot. Matters on co-located claims, combined-visit documentation, and unified patient-pay.
- We do not sell software. We work inside athenahealth, Kareo/Tebra, AdvancedMD, eClinicalWorks, or whatever PM/EHR you run. No rip-and-replace.
- We do not sell AI as the product. CodaMetrix and the autonomous-coding category solve a slice. We run the full cycle, humans accountable for outcomes. AI is in our stack where it reduces error.
FAQ
How long does onboarding take for a 40-provider group?
Typical transition is 60-90 days. Weeks 1-3: discovery, credentialing audit, payer enrollment verification. Weeks 4-6: parallel production on a subset. Weeks 7-12: full cutover with legacy A/R runoff handled separately. We do not promise 30-day onboarding at this size. Neither should anyone else.
Do you work inside our existing EHR/PM system?
Yes. athenahealth, Epic, eClinicalWorks, NextGen, Kareo/Tebra, AdvancedMD, and most other major platforms. No software change required. Switching platforms is a separate decision from switching billing vendors.
Who owns the data and A/R during and after the engagement?
You do. EHR/PM stays yours. Claims, remits, and A/R history stay yours. Contract includes a 90-day offboarding clause with full data extract at no extra fee.
How do you handle HIPAA and offshore risk?
Signed BAA. SOC 2 Type II. Role-based access. No PHI on local drives offshore. Thin-client workstations into a US-hosted environment. Background-checked staff. Named offshore lead per account.
Can we start with credentialing only, or denial management only?
Yes. Many groups start scoped — credentialing-only for a backlog, or denial recovery on 90+ A/R — and expand. It lets both sides see operational fit before a full RCM transition.
Request a per-provider TCO analysis
Send us your provider count, specialty mix, current PM/EHR, and last 12 months of gross charges and net collections. Within 10 business days you get a written TCO comparison: your current all-in RCM cost per provider versus a Revenant Care scope that matches it, line by line. No slide deck. No discovery call required.
Related: Revenue Cycle Management · Physician Credentialing Services · Medical Coding
Related services and pages
Revenant Care covers the full specialty stack. If your organization operates multiple service lines, your RCM partner should too.
- Mental Health Billing — CoCM and integrated BH services under 99492-99494 and G2214.
- ABA Billing — Pediatric practices with embedded ABA services.
- Technology Platform — RVU reconciliation, denial prediction, and multi-provider dashboards.
- Medical Coding — E/M, procedure, and modifier coding aligned to your comp plan.
- Provider Credentialing — Group and individual CAQH, multi-location enrollments.