Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for healthcare services. It involves converting diagnoses and procedures into ICD-10, CPT, and HCPCS codes, submitting to payers, and managing payment posting, denial management, and AR follow-up. Provider’s Healthcare PM Advisors manages every step with AAPC-certified billers specialized in your specific specialty.

Reducing denials starts before a claim is submitted. The most effective strategies include real-time eligibility verification, prior authorization management, AI-assisted claim scrubbing, specialty-specific CPT and ICD-10 coding accuracy, and consistent denial pattern monitoring. With the national average at 12%, practices with disciplined processes achieve denial rates below 2%. Read our full denial guide →

Most commercial payer credentialing takes 60–120 days from application to approval. Medicare and Medicaid can take 90+ days depending on the state. The most common delays are incomplete applications and missing documentation. Our credentialing specialists track every application actively — following up at regular intervals to prevent stagnation in processing queues.

Revenue Cycle Management is the complete financial process from the moment a patient schedules an appointment to the moment their balance is paid in full. It covers eligibility verification, prior authorization, charge capture, medical coding, claim submission, payment posting, denial management, AR follow-up, and patient collections. When all steps are managed efficiently, your practice collects everything it has earned — with fewer delays and better financial visibility.

Yes — when done through a qualified, compliant partner. Any billing company handling Protected Health Information (PHI) must sign a Business Associate Agreement (BAA) with your practice. Provider’s Healthcare PM Advisors is fully HIPAA-compliant. We sign BAAs with every client, maintain AES-256 encrypted data handling, restrict PHI access to authorized personnel, and conduct regular compliance reviews including No Surprises Act alignment.

Insurance eligibility verification confirms a patient’s coverage is active and identifies deductibles, copays, coinsurance, and in-network status — before the appointment. A major portion of claim denials trace directly back to front-end eligibility errors. Patients switch plans, coverage lapses, and in-network status changes. We verify eligibility for every patient before every visit, catching coverage issues at scheduling rather than weeks after a claim has been denied.

Prior authorization is the payer approval required before certain services, procedures, or medications are provided and reimbursed. Required for most surgeries, advanced imaging, specialty referrals, and high-cost medications. With the 2026 CMS Prior Authorization API Rule now requiring electronic processing, managing prior authorization is more critical than ever. Yes — we handle it entirely on your behalf: submit requests, track approvals, follow up with payers, and document every authorization.