Medical Billing FAQs: Answers for U.S. Practices

SkyLine MB is a medical billing and revenue cycle management company for U.S. healthcare practices. We support eligibility verification, coding review, claim submission, payment posting, denial management, A/R follow-up, credentialing and practice reporting, either as a full revenue cycle service or for selected parts of it.

We support solo physicians, small and mid-sized group practices, multispecialty clinics, therapy practices, urgent care centers, ambulatory surgery centers and specialty practices across the United States.

No. Some practices hand over the full billing workflow, while others outsource only denials, A/R cleanup, credentialing, prior authorizations or coding review. The scope is agreed before work starts.

Onboarding time depends on your specialty, the number of providers, your software access and the condition of existing A/R. We confirm a realistic timeline during the discovery call, after reviewing your current workflow.

Typically we need system access to your EHR or practice management software, payer and fee schedule information, provider details, recent billing reports and an open A/R list. We sign a Business Associate Agreement before accessing patient information.

Yes. Each practice is assigned a billing contact who coordinates questions, documentation requests and monthly reporting with your team.

Pricing depends on your specialty, claim volume, collections, payer mix, the services included and the condition of existing A/R. Common models are a percentage of collections, a per-claim fee or a fixed monthly fee. We provide a written proposal after reviewing your practice.

Any setup work, such as cleaning up old A/R or completing payer enrollments, is identified and quoted in advance. Nothing is added to your bill without being agreed in the proposal.

Yes. A free billing review looks at a sample of your claims, denials and open A/R so you can see where revenue may be delayed or lost before deciding whether to outsource.

Collection-based fees are defined in the agreement, including which payments count. We explain this clearly in the proposal so there are no surprises on your monthly invoice.

The agreement sets out the notice period and the transition steps, including returning reports, open items and work-in-progress so your next team can continue without gaps.

We aim to submit claims within 24–48 hours of receiving complete charge information and documentation. Claims missing information are flagged back to your team rather than submitted incomplete.

Your providers remain responsible for documentation and clinical decisions. Our coding review checks that the codes and modifiers on the claim are supported by the documented encounter and the payer’s rules, and questions go back to the provider.

Yes, where it is included in your scope. We verify active coverage, plan details, copays, deductibles and whether prior authorization or referrals are required, so problems are found before the visit rather than after the denial.

A clean claim rate is the share of claims accepted by the payer on first submission without rejection or correction. It is one of the measures we report monthly, along with the reasons behind any rejections.

Yes, if included in your scope. We can prepare patient statements and support a patient billing help desk that answers balance and payment questions on your behalf.

Yes. After the primary payer adjudicates, we submit eligible balances to secondary or tertiary coverage according to coordination-of-benefits rules.

Each denial is reviewed for its reason code and root cause. We correct and resubmit eligible claims, prepare appeals with supporting documentation where appropriate, and report repeating denial patterns so they can be prevented.

Yes. We review aging claims by payer and age bucket, confirm which are still within filing and appeal limits, and prioritize follow-up on the balances most likely to be recovered.

We post insurance and patient payments from ERAs, EOBs and deposits, record adjustments, and flag underpayments or unexpected denials for follow-up.

Posted payments are compared against expected reimbursement based on your fee schedules and payer contracts. Variances are investigated and pursued with the payer when appropriate.

Each payer sets a deadline for submitting claims and appeals. Original Medicare generally allows 12 months from the date of service for claim submission, while commercial and Medicaid plans set their own limits. We track these deadlines as part of follow-up.

Yes. We assist with payer enrollment applications, CAQH profile updates and attestations, revalidations and follow-up with payers until enrollment is confirmed.

Credentialing timelines vary by payer and state and are often measured in months. Starting early and keeping CAQH information current helps avoid delays in billing for new providers.

Yes. We can submit and track prior authorization requests, follow up with payers, and check that the approved service, codes, dates and location match what is scheduled.

We review the payer’s rules and any retro-authorization or appeal options. Some cases can be corrected; others cannot, which is why we focus on checking authorization requirements before the service.

We follow applicable HIPAA requirements, sign a Business Associate Agreement before accessing protected health information, and use role-based access so team members only see what their work requires.

No. We work inside your existing EHR or practice management system wherever possible. If you use a platform we have not worked with before, we confirm access and workflow during onboarding.

You receive regular reporting that typically includes charges, collections, denials by reason, A/R aging by payer, claims awaiting information and other agreed KPIs, plus a review call to discuss the results.

Your practice owns its patient and billing data. Our access is governed by the service agreement and the Business Associate Agreement.

We support a wide range of specialties, including cardiology, orthopedics, mental health, physical, occupational and speech therapy, ABA therapy, pain management, gastroenterology, dermatology, urology, nephrology, wound care, laboratories, urgent care and more. See our specialties page for the full list.

Each specialty has its own codes, modifiers, documentation requirements and payer policies. Billing teams that understand those rules can catch problems before submission instead of after a denial.

Yes. Multispecialty groups can be billed with specialty-specific rules applied by provider, location and service line, with reporting broken down the same way.