Disclosure: Fastora Medical Billing Solutions publishes this guide and is one of the companies profiled in it. We list ourselves first and tell you that plainly — judge us by the same criteria we apply to everyone else on this page. No company paid to be included, and no outside organization created or endorsed this ordering.
Virginia billing has a single front door and many rooms behind it. Since October 1, 2023, every Virginia Medicaid member — managed care and fee-for-service alike — sits under one program, Cardinal Care, administered by the Department of Medical Assistance Services (DMAS). But one program does not mean one set of paperwork: providers must enroll with DMAS, keep that enrollment current through revalidation in the PRSS portal, and hold a separate contract with each MCO whose members they treat. Miss a revalidation or bill a plan you are not contracted with, and otherwise clean claims stop paying. The company you choose needs Virginia-specific enrollment discipline, not just claims processing. This guide profiles six companies that bill for Virginia practices in 2026. If you want the service itself rather than a comparison, start with Fastora’s medical billing services in Virginia.
How we evaluated these companies
- Cardinal Care enrollment fluency — does the company track DMAS enrollment and PRSS revalidation and manage separate contracts with each MCO, or will you discover a lapse through denials?
- Specialty coding depth — Virginia volume concentrates in psychiatry and behavioral health, ABA therapy, cardiology, and therapy services; coding has to fit the specialty.
- Denial and A/R work — who appeals, rebills, and pursues aged receivables, versus who only reports them back to you?
- EHR and workflow fit — will the company bill inside the system your practice already runs?
- Pricing and contract clarity — is pricing published or quoted only after a sales process, what does the scope include, and is there a long-term lock-in?
- Practice-size fit — a solo practice in Roanoke, a growing Northern Virginia group, and a hospital-affiliated clinic need different things from a billing partner.
The companies at a glance
| # | Company | Best for | Type |
|---|---|---|---|
| 1 | Fastora Medical Billing Solutions | Virginia practices wanting full-cycle billing with Cardinal Care enrollment and revalidation handled as operations | Billing service / RCM |
| 2 | FC Billing, LLC | Mental health, TMS, and specialty practices wanting a founder-led, full-cycle team | Billing service / RCM |
| 3 | NOVA Medical Billing, Inc. | Ophthalmology, neurology, and GI practices wanting a certification-heavy local team | Billing service / RCM |
| 4 | Capture Billing & Consulting | Established private practices wanting billing paired with practice consulting | Billing service / consulting |
| 5 | Avosina Healthcare Solutions | Groups wanting billing combined with analytics software and IT support | RCM + IT services |
| 6 | Physicians Revenue Group (PRG) | Practices wanting billing with credentialing and billing/coding audits in the same engagement | Billing service / RCM |
1. Fastora Medical Billing Solutions
Fastora works with Virginia practices remotely — it has no Virginia office — and builds its workflow around Cardinal Care’s enrollment mechanics. Because providers must stay enrolled with DMAS, revalidate on schedule through PRSS, and hold a separate contract with each MCO whose members they treat, enrollment and contract status are checked as part of billing operations rather than discovered after a denial. The service covers the full cycle: eligibility verification, coding, claims submission, denial management, A/R recovery, payment posting, and credentialing support. Behavioral health is a particular focus — Fastora publishes dedicated resources on psychiatry and mental health billing — and multi-state practices can review its medical billing services beyond Virginia.
More than 5 years in medical billing and revenue cycle management, 100+ physicians supported, 50+ active clients: that is Fastora’s reported track record. Virginia practices pay a percentage of collections or a flat monthly fee, quoted after a free billing assessment so the scope is settled before signing.
Strengths: Cardinal Care enrollment and PRSS revalidation treated as daily operations, with the full cycle including A/R recovery in one service. Considerations: Fastora serves Virginia remotely; practices that want a billing team on site should weigh that.
Best fit: independent and group practices — psychiatry, behavioral health, and ABA among them — that want one team accountable for enrollment, coding, and denial follow-up.
2. FC Billing, LLC
FC Billing is a founder-led billing company based in Lansdowne, in Loudoun County. Its published scope is the full cycle — claim submission, coding, payment posting, A/R management, credentialing, insurance enrollment, and eligibility checks — with a specialty emphasis that includes mental health, TMS, and Spravato practices alongside gastroenterology, dermatology, and ophthalmology. It serves multi-provider practices, group practices, and hospital-affiliated clinics, and it publishes two terms practices often have to ask for: no setup fees and no long-term contracts, with pricing set by specialty and claim volume rather than a single published rate. It also states that it works inside the EHR platforms a practice already uses, across more than 30 systems.
Strengths: a Virginia-based, full-cycle team with real behavioral health depth and published no-setup-fee, no-lock-in terms. Considerations: it is a boutique, founder-led firm — very large health systems should confirm capacity.
3. NOVA Medical Billing, Inc.
NOVA Medical Billing is based in Chantilly, in Fairfax County, and provides billing, coding, RCM, credentialing, and compliance services, with named specialty depth in ophthalmology, neurology, pulmonology, gastroenterology, and dermatology. Its distinguishing feature is certification density: the company publishes a long list of staff credentials across AAPC and other industry bodies (including CPC, CPB, CPMA, CPPM, and CPCO) and states that every biller must earn the AAPC Certified Professional Biller credential within the first year of employment.
Strengths: credentialing and compliance depth backed by a formally certified team — a good match for specialty practices where coding audits are a real risk. Considerations: the specialty center of gravity is eye, neuro, GI, and pulmonary work; practices outside those areas should confirm depth in their own specialty.
4. Capture Billing & Consulting
Capture Billing & Consulting, headquartered in South Riding, Virginia, was founded in 2004 by a practicing physician and serves practices nationally from its Loudoun County base. Its model pairs billing — delivered by billers and certified professional coders — with practice-management consulting, so the scope extends beyond claims into charge entry, EOB posting, A/R follow-up, patient statements, and monthly reporting. It has also built dedicated divisions for individual specialties over the years, including OB/GYN and ENT.
Strengths: a physician-founded Virginia firm with two decades of operating history and consulting layered onto billing — well suited to established private practices that want operational advice, not just claims filed. Considerations: practices that only need billing should scope the engagement tightly so they are not paying for consulting they will not use.
5. Avosina Healthcare Solutions
Avosina Healthcare Solutions, based in Lorton, Virginia and founded in 2004 by physicians, is an RCM and IT management firm rather than a pure billing service. Alongside full end-to-end revenue cycle management, it sells services à la carte — certified coding, credentialing, MIPS attestation support, IT support — and offers its own analytics platform, halaX, which sits on top of a practice’s existing EMR and practice-management systems to report revenue cycle data. Its published delivery model is hybrid, combining onshore and offshore billing capacity.
Strengths: analytics and IT depth under the same roof as billing, with flexible à la carte scoping. Considerations: the hybrid delivery model means you should ask where each function for your account is performed, and the breadth makes a tightly written scope essential.
6. Physicians Revenue Group (PRG)
Physicians Revenue Group publishes a Virginia-specific service line covering medical billing, provider credentialing and re-credentialing, billing and coding audits, eligibility verification, and denial management for Virginia practices. The audit offering is the differentiator: PRG positions its audits as a way to find where revenue is leaking — coding errors, missed charges, compliance gaps — which makes it a reasonable first engagement for a practice that suspects problems but has not yet decided to switch billers outright.
Strengths: credentialing plus a genuine audit service in the same engagement, useful for practices that want diagnosis before — or alongside — a billing change. Considerations: PRG is a national firm serving Virginia rather than a Virginia-rooted one; ask how its Virginia accounts are staffed and how Cardinal Care enrollment is handled day to day.
How to choose for your Virginia practice
Start with enrollment, because in Virginia that is where claims quietly die. Under Cardinal Care, your practice has to stay enrolled with DMAS, revalidate on time through PRSS, and hold a contract with every MCO whose members you see — ask each candidate who owns those tasks after onboarding, and what happens when a new provider joins mid-contract. Then weigh specialty fit: psychiatry, behavioral health, and ABA volume is heavy in Northern Virginia, while cardiology and therapy dominate elsewhere. Compare pricing only at equal scope — whether credentialing, authorizations, patient statements, and old A/R are inside the rate changes what a percentage actually costs you. Finally, match the firm to your size and style: a founder-led Loudoun County boutique, a certification-heavy Fairfax County team, and a national RCM-plus-IT vendor are three different relationships.
Frequently asked questions
What is Cardinal Care, and why does it matter for billing?
Cardinal Care is Virginia’s Medicaid program, administered by the Department of Medical Assistance Services (DMAS). Since October 1, 2023, all Virginia Medicaid members — managed care and fee-for-service — have sat under that single program. The operational catch is that one program still requires separate pieces of paperwork: enrollment with DMAS kept current through revalidation in the PRSS portal, and a separate contract with each managed care organization whose members you treat. A billing company working in Virginia has to track all three, because a lapse in any one stops payment on otherwise clean claims.
How much does it cost to outsource medical billing in Virginia?
Most companies price either as a percentage of collections or as a flat monthly fee, and several firms here quote by specialty and volume rather than publishing a single rate — one publishes no setup fees and no long-term contracts as standard terms. Percentages are only comparable at equal scope: confirm whether credentialing and revalidation tracking, authorizations, patient statements, and old A/R recovery are inside the rate or billed separately. Fastora quotes a percentage of collections or a flat monthly fee after a free billing assessment.
Does my billing company need to be located in Virginia?
No. Claims are filed electronically, and companies on this list serve Virginia from both inside and outside the state. What matters is whether the company works Virginia’s rules correctly — Cardinal Care enrollment and PRSS revalidation, per-MCO contracts, and each plan’s authorization and filing requirements. A Virginia address can help with familiarity, but a remote company with disciplined enrollment tracking will outperform a local one without it.
What should I ask a billing company about credentialing and enrollment?
Ask who owns enrollment maintenance after the initial setup, how PRSS revalidation dates are tracked, whether the company manages your separate contracts with each Cardinal Care MCO, and what happens when a new provider joins mid-contract. In Virginia, enrollment is not a one-time event: an expired revalidation or a missing MCO contract turns payable claims into denials, so the answer should describe an ongoing process with named owners, not a setup task.
Can a new billing company take over our old accounts receivable?
Most full-service companies will work aged A/R as part of onboarding or as a defined add-on. Get the scope in writing: which aging buckets are included, how far back they will pursue, and whether recovery is inside the standard rate or priced separately. Claims near a plan’s filing or appeal deadline should be triaged first — in a managed-care-heavy state, the oldest recoverable dollars usually sit in enrollment and authorization denials, which are fixable only while appeal windows remain open.
Will we have to change our EHR to outsource billing?
Usually not. Most billing services on this list work inside the EHR system your practice already runs — one states it works across more than 30 platforms, and another’s analytics software is designed to sit on top of your existing systems rather than replace them. Confirm your exact system by name before signing.
Conclusion
Virginia rewards billing companies that treat Cardinal Care enrollment, revalidation, and per-plan contracts as daily operations rather than paperwork. Compare the six companies above on the criteria that match your practice — enrollment discipline, specialty coding depth, real denial and A/R work, and pricing scope you can verify line by line.
Looking for a more reliable medical billing partner? Fastora Medical Billing Solutions provides medical billing and revenue cycle management support for Virginia practices. Request your free initial billing audit to discuss your practice’s billing workflow and identify potential areas for improvement.
Sources: service descriptions are drawn from each company’s own published materials (FC Billing, NOVA Medical Billing, Capture Billing & Consulting, Avosina Healthcare Solutions, Physicians Revenue Group), reviewed October 2026. Cardinal Care facts are drawn from Virginia Department of Medical Assistance Services (DMAS) program materials. Fastora company figures are company-reported.
