Clean Claim Rate
Average Denial Reduction
Claims Processed Monthly
Connecticut Practices Served
Measured across active client accounts, trailing 12 months. Clean claim rate reflects first-pass acceptance before resubmission. Denial reduction compares each client’s first 90 days on our system to their prior billing vendor.
Internal medicine focuses only on adult patients, many of whom have multiple chronic conditions. Visits are often more complex and require higher-level E/M coding. Practices also bill more often for chronic care management, transitional care, and Medicare services while coordinating treatment with specialists.
Connecticut internal medicine practices often care for Medicare and HUSKY Health patients with ongoing health conditions. That makes accurate eligibility checks, Annual Wellness Visit rules, chronic care documentation, and timely Transitional Care Management billing especially important after hospital discharge and specialist referrals.
Fewer undercoded high-complexity visits
Transitional care billed within the required window
Chronic care management documented and billed correctly
HUSKY and Medicare eligibility checked before every visit
More time for patient care, less time on claim follow-up
Every scheduled patient is verified before the visit to confirm active Medicare, HUSKY, or commercial coverage before a claim is ever submitted.
We code each visit based on the actual medical decision making documented, reviewing chronic condition count and treatment complexity rather than applying a default level.
Claims are reviewed, coded, and submitted within one business day of receiving complete documentation. Payments get matched against the ERA or EOB the same week they arrive.
Denials get reviewed for root cause and appealed within the payer's filing deadline. We work to resolve the issue quickly and help prevent the same denial from happening again.
HIPAA Compliant
Connecticut Only
Dedicated Account Manager
Certified Coders
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We match the E/M code to the actual medical decision making documented, including the number of conditions managed and complexity of treatment decisions. This prevents both denials and lost revenue from undercoding.
TCM requires initial contact with the patient within two business days of discharge and a face-to-face visit within a set number of calendar days after that. We track this window against every discharge referral we receive.
Yes, as long as documentation supports both services separately. We track monthly CCM time apart from regular visit coding to avoid overlap.
We verify both coverages before the visit and bill in the correct order, submitting to Medicare first and the secondary payer after, following standard coordination of benefits rules.
Yes. We code Annual Wellness Visits under Medicare's specific HCPCS codes, separate from standard problem-focused visits.
The two codes are distinguished by the complexity of medical decision making required during the post-discharge period, not simply whether the visit happened within the window.
MIPS does not change how a claim is coded, but it does affect Medicare reimbursement adjustments based on reported quality measures. We keep coding accurate regardless of a practice's MIPS participation status.
The most common causes are undercoded complex visits, missed TCM windows, and eligibility gaps for patients with coordination of benefits issues.
Filing limits vary by payer, typically ranging from 90 days to one year. We track each payer's specific deadline so appeals are never missed.
We track referral documentation as it relates to billing accuracy, though the referral itself is a clinical, not billing, decision made by the provider.
