Generic billing loses money. Your specialty has its own codes, payer rules, and denial patterns. We assign billers who know your field, not billers who guess their way through it.
Practices that use generalist billing services leave money on the table in ways that never appear on a denial report. The errors are invisible because the claims clear adjudication as technically valid, but are coded at a lower level than what was actually performed and documented. Specialty-specific billing closes that gap.
Cardiology alone spans codes 93000 through 93799. A coder who treats those codes the same way they treat an office visit (99213 or 99214) will produce clean-looking claims that still get denied. Specialty-specific billing means knowing which code belongs to which procedure before the claim is even built.
Blue Cross may approve an echocardiogram (93306) at 100% of fee schedule in one state and apply a separate bundling rule that cuts reimbursement by 40% in another. Payer-specific policy knowledge is not optional when your revenue depends on getting those rules right every time.
Modifier 59 (distinct procedural service) and modifier 25 (significant, separately identifiable E/M service) are two of the most audited modifiers in Medicare. Used correctly, they protect your reimbursement. Used incorrectly, they trigger prepayment audits. Specialty billers know where each one applies and where it does not.
Orthopedics sees a high volume of medical necessity denials tied to physical therapy prerequisites. Mental health claims run into frequency limitations and session-count edits. Dermatology faces bundling disputes on lesion removals. Each specialty has its own denial fingerprint, and fixing it requires knowing that fingerprint in advance.
These eight specialties represent the highest search volume and the most complex billing environments we work in. Each page covers the specific codes, payer rules, and denial patterns that matter for that field.
Cardiac billing covers a wide range from diagnostic codes like 93306 (echocardiography) through interventional procedures. Payer editing is aggressive. Our cardiology team works with Medicare LCDs and commercial payer policies specific to cardiac services.
Learn moreOrthopedic billing involves surgical codes, fracture care, and physical therapy co-management that require precise modifier application. We handle the documentation requirements that tie CPT codes like 27447 (total knee replacement) to payer approval.
Learn moreBehavioral health billing runs through CPT codes 90837 and 90834 with strict session limits and prior authorization requirements by payer. Our team tracks frequency limitations and mental health parity rules so your claims do not stall.
Learn moreDermatology claims for lesion removal (17000 to 17004 series) and biopsies (11102 to 11107) are routinely bundled incorrectly. We separate billable procedures accurately and document medical necessity to defend each line item.
Learn morePT billing depends on timed codes (97110, 97530), functional limitation reporting, and Medicare cap exceptions. Our physical therapy billing team tracks the KX modifier threshold and flags claims before they hit the cap without documentation.
Learn moreUrgent care billing combines E/M leveling (99202 to 99215), procedure codes, and facility fee questions that vary by payer. High claim volume means errors compound quickly. Our team processes urgent care claims with built-in level-of-service audits.
Learn moreOB/GYN billing includes global obstetric packages (59400, 59510), prenatal visits, and gynecologic procedure codes with strict documentation requirements. We manage global billing timelines and unbundle correctly when partial services apply.
Learn moreGI billing centers on colonoscopy and endoscopy codes (43239, 45378 to 45392) with add-on codes and polyp removal distinctions that are frequently miscoded. Our GI team applies the correct base and add-on code combinations to protect full reimbursement.
Learn moreGetting matched to the right billing team is not random. We follow a structured process from intake through ongoing audits to make sure your specialty knowledge gap is closed before the first claim is submitted.
Before we touch a single claim, we conduct a specialty intake review. We pull your last 90 days of denial data, map your payer mix against your specialty code volume, and identify the highest-frequency billing errors in your current operation. This assessment tells us exactly where your revenue is leaking.
Based on your specialty and payer mix, we assign a billing team with direct experience in your field. You also receive a named account manager who coordinates between your clinical staff and our billing operation. No generic call center. No ticket queue. A person you know by name.
We run a full denial pattern analysis against your specialty's known triggers. Cardiology practices see different denial profiles than dermatology or behavioral health. We build a specialty-specific denial prevention checklist into your claim scrubbing workflow before submissions go out.
Every 30 days, your billing team conducts an internal coding audit against a sample of submitted claims. We check modifier accuracy, code specificity, documentation linkage, and payer-specific edit compliance. Audit results feed back into your workflow so the same error does not appear twice.
These are the questions practice managers ask us most often before signing on. Direct answers, no sales language.
We maintain specialty-focused billing teams, not one-per-specialty silos. Each team concentrates on a cluster of related specialties with overlapping code sets and payer behavior. A team that handles orthopedics also handles sports medicine and pain management because the coding environment overlaps.
Multi-specialty groups are common and we handle them regularly. We assign a primary billing coordinator who understands the dominant specialty in your practice and has access to our internal resources for the secondary specialties.
Our overall clean claim rate is 98.2% across all specialties. Industry average for medical billing sits between 75% and 85% first-pass acceptance. The gap comes from pre-submission claim scrubbing that checks NCCI edits, LCD/NCD coverage rules, and payer-specific modifier requirements.
For established specialties in our portfolio (cardiology, orthopedics, physical therapy, and others with dedicated teams), the onboarding period is 2 to 3 weeks. That covers EHR access setup, payer contract review, denial history pull, and the first clean claim submission cycle.
Yes. Each billing team monitors LCD updates from the MAC that covers your state, commercial payer bulletins for the top 5 payers in your mix, and CMS fee schedule updates that affect your specialty codes.
Mid-year transitions are one of the more common scenarios we handle. We start with a claims audit of your open receivables, identify what is collectible versus what is past timely filing, and rebuild your clean claims process from the current date forward.
Stop losing revenue to generic billers who treat a dermatology claim the same way they treat a family medicine visit. A free billing audit will show you exactly where specialty-specific errors are costing your practice money right now.
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