Medical Billing Services

What our medical billing services cover

Fastora's medical billing services cover each step that turns a patient visit into a paid claim: insurance checks before the visit, charge entry and coding review, claim scrubbing and submission, payment posting, denial work, A/R follow-up and patient statements. Every claim is handled by certified medical billing and coding professionals.

You can hand us the whole cycle as end to end medical billing services, or start with the part that is causing the most trouble, such as aging A/R or rising denials, and add scope later. Many practices compare a full service medical billing arrangement with a back-end-only arrangement before deciding; the free assessment helps you see which fits. Not sure where your revenue is leaking? Our billing stress test gives you a quick diagnostic.

This page explains how the billing work runs day to day. If you are still deciding whether to bring billing outside the practice at all, our page on outsourcing your billing compares the in-house and outsourced models side by side.

Stage	What the billing team does	What it protects
Before the visit	Eligibility and benefits checks, prior authorization requests, co-pay amounts confirmed	Coverage and authorization denials
After the visit	Charge entry, CPT, ICD-10-CM and HCPCS coding review, modifier checks	Coding and bundling denials, under-coding
Submission	Advanced Pre-Submission Claim Review, then electronic 837P submission through your clearinghouse	Front-end rejections and missed filing limits
Payment	ERA/835 and paper EOB posting, reconciliation against deposits	Unapplied payments, missed underpayments
Follow-up	Denial analysis, appeals, A/R follow-up by payer and age	Write-offs from claims nobody worked
Patient balance	Statements, payment plans, balance questions	Self-pay balances that age past collection

Our billing workflow, step by step

Fastora organizes the work in three phases. A Virtual Assistant phase covers scheduling, registration, insurance verification and co-pays collected upfront. A Scriber phase records visit documentation in the EHR in real time. The Fastora Medical Billing phase covers claim submission, payment posting, denial management, A/R follow-up and patient billing. You can use all three phases or only the billing phase.

Eligibility & benefits

Medical insurance billing services start before a claim exists: coverage is checked before the appointment, not after the denial. The team confirms the plan is active, whether the provider is in network, the patient's deductible and co-pay, and whether the service needs a referral or eligibility and prior authorization work before it is performed. Missing details go back to the front desk while the patient can still fix them.

Charge entry & coding review

Charges are entered from the signed visit note. Certified coders check that CPT and HCPCS codes match the documentation, that ICD-10-CM diagnosis codes support medical necessity and are coded to the highest specificity the note allows, and that modifiers are used only where the rules call for them. Questions go back to the provider as a short query rather than a guess.

Claim scrubbing & submission

In our medical claims billing services, every claim passes through Advanced Pre-Submission Claim Review, Fastora's claim scrubbing step. It catches missing or mismatched demographics, invalid code pairs, NCCI bundling conflicts, missing authorization numbers and payer-specific formatting rules. Clean claims go out electronically as X12 837P professional claims, the HIPAA standard transaction for the data on a CMS-1500 form, through your clearinghouse.

Clearinghouse and payer rejections are worked daily, because a rejected claim never reached the payer and still counts against the filing deadline. Medicare, for example, generally requires claims to be filed within 12 months of the date of service under 42 CFR 424.44; commercial and Medicaid limits vary by plan and contract.

Payment posting & reconciliation

Payments are posted from electronic remittance advice (the X12 835 transaction, or ERA) and from paper EOBs. Each posting is reconciled against the bank deposit, and adjustment codes are read rather than written off by default, so contractual adjustments, patient responsibility and denials each land in the right place. Credit balances are flagged for review.

Denials & appeals

Every denial is sorted by its CARC and RARC codes, corrected and resubmitted or appealed within the payer's deadline, and logged by root cause. The pattern report matters as much as the individual appeal: if one payer keeps denying the same code, the fix belongs upstream at registration, authorization or coding. Our denial management and appeals page covers the process in detail.

A/R follow-up

Unpaid claims are worked by payer and by age bucket, starting with the highest balances closest to their filing or appeal limits. Follow-up uses payer portals and calls, and each touch is noted in your system so anyone can see where a claim stands. Older A/R cleanup can be added as a separate project.

Patient billing

Once insurance has paid, the remaining balance goes to the patient on a clear statement. The team answers balance questions, sets up payment plans within your policy and follows the schedule you approve. Uninsured or self-pay patients also need a good faith estimate under the No Surprises Act, which the front-end workflow can prepare.

Medical billing and coding services under one team

Billing errors and coding errors are often the same problem seen from two sides. When the people who code a claim also see its denial, they can trace the problem back to the documentation or the code choice and fix it for the next claim, not just this one.

That is why Fastora offers medical billing and coding services together. Coding work includes CPT, ICD-10-CM and HCPCS assignment, E/M level review, modifier review and periodic coding audits. If you already have coders in-house, we can work from their codes and add a review step instead. The medical coding service page explains audit scope and how findings are reported.

• E/M review: level selection checked against the documented medical decision making or total time.
• Modifier review: modifiers such as 25 and 59 checked against the payer's rules before submission.
• Diagnosis specificity: ICD-10-CM codes coded to the level the note supports, following the official coding guidelines.
• Audit feedback: short, specific notes to providers on recurring documentation gaps.

Physician billing services for every practice type

Physician and doctor billing services look different in a solo office, a growing group and a clinic with several sites. The workflow above stays the same; what changes is how the work is organized around your providers, locations and payers.

Medical billing for doctors in solo and small offices

In a small office, one person often handles the front desk and the billing. Medical billing for doctors at this size is mostly about consistency: claims out every day, rejections fixed the same week, follow-up that does not stop when someone is on leave. Private practices use this support when billing cannot depend on one person. Our small practice billing page covers start-up setup and what to ask about minimums.

Medical billing services for group practices and clinics

Medical billing services for group practices need reporting by provider, location and payer, so partners can see where revenue and denials come from. Medical billing services for clinics also need rules for shared front-desk staff, multiple fee schedules and providers who credential at different times.

Medical billing for multi-location practices

With several sites, the same payer can be billed under different service locations and sometimes different tax IDs or group NPIs. Medical billing for multi-location practices therefore depends on accurate place-of-service and service-facility data on every claim, enrollment that covers each address, and reports you can filter by site.

Medical billing services for nurse practitioners and other non-physician practitioners

Nurse practitioners, physician assistants and other non-physician practitioners can enroll in Medicare and bill under their own NPI. Medicare's incident-to rules allow some services to be billed under the supervising physician's NPI only when specific supervision and plan-of-care conditions are met, and commercial payers set their own policies. Medical billing services for nurse practitioners include checking which rendering provider belongs on each claim.

Specialty-specific billing teams

Payer rules differ sharply by specialty. Psychotherapy claims depend on time-based codes and session limits, therapy claims on timed units and plan-of-care rules, and surgical specialties on global periods and modifiers. Fastora assigns each practice to billing and coding professionals who work that specialty's codes and payer policies.

Browse the full list of specialties we bill for, grouped below by behavioral health, therapy and rehab, physician specialties and facilities.

Services you can add to core billing

Core billing covers the cycle from charge to payment. Practices often add front-end and advisory services as they grow, or bring in one service on its own to fix a specific gap. The map below shows how each service connects to the revenue cycle management process.

Technology & EHR/PM integrations

Fastora works inside your existing EHR/PM system under user access your practice grants. There is no software to install and no data migration. Claims, notes and payments stay in your system, so your staff can see every account the billing team touches.

Because the work happens in your system and through your clearinghouse, Fastora does not claim official integrations or partnerships with any software vendor. During the assessment we confirm what access your system supports and set up named user accounts for the billing team.

This setup is what makes remote medical billing services practical. The billing team works inside your systems remotely, and you keep in touch through your dedicated account contact, scheduled review calls and 24/7 client support.

See how Fastora works inside your EHR and PM system for the systems practices ask about and how access is set up. We work inside your EHR — including athenahealth billing support, eClinicalWorks billing support, and Kareo billing support.

HIPAA compliant medical billing services

Any company offering healthcare billing services handles protected health information on every claim, so HIPAA treats it as a business associate. Fastora signs a Business Associate Agreement (BAA) before accessing any PHI, as the HIPAA Privacy Rule requires for business associates.

• Workflows aligned with HIPAA and HITECH.
• Encryption and secure server environments.
• Strict access controls, with named user accounts in your system that you can review or revoke.
• Regular internal audits of access and billing work.

When you compare any billing vendor, ask to see its BAA before the contract, ask how user access is granted and removed, and ask what happens to your data access if the agreement ends.

Reporting you receive every month

You get transparent dashboards plus monthly performance reporting and a monthly review call with your dedicated account contact. Custom reports are available on request. The aim is a short set of figures you can act on, not a long export.

Report	What it shows	Question it answers
Charges, payments and adjustments	Totals by provider, location and payer	Is revenue moving as expected?
A/R aging	Open balances by payer in age buckets	Where is cash stuck, and for how long?
Denials by reason	Denials grouped by CARC/RARC and root cause	What should change upstream?
First-pass claim results	Claims paid or rejected on first submission	Are claims going out clean?
Patient balances	Self-pay balances and payment plan status	Is the patient side under control?

Each review call ends with a short list of actions, for example a registration step to tighten or a payer to escalate, so the reports lead to changes in the practice.

Choosing a medical billing service provider

Searches for medical billing services in the USA return many vendors with similar claims. A useful comparison focuses on how the work is done rather than on marketing figures. Ask each medical billing service provider these questions:

1. Who codes and bills my claims, and what certifications do they hold?
2. Will I have one named contact, or a shared support queue?
3. Do you work in my EHR/PM system, or move my data into yours?
4. What do monthly reports include, and can I see a sample?
5. How are denials tracked by root cause, not just resubmitted?
6. What is in the fee, what is extra, and are there setup fees?
7. How do you hand back open claims and A/R if we part ways?

Our guide to choosing a billing company goes deeper on contract terms and red flags, and the free assessment is a practical way to test these answers against your own claims.

Pricing overview

Fastora quotes after a free billing assessment, because the right price depends on your specialty, claim volume, payer mix, A/R backlog and the services you include. Pricing models may be a percentage of collections, a flat fee per claim or a hybrid of the two. There are no hidden setup fees.

Our billing pricing page explains how each model works and what changes a quote, and includes a calculator to estimate your current in-house cost.

Starting a practice or opening a new location? Begin with medical billing for a new practice.