MEDICAL BILLING SERVICES

Medical Billing Services to Help U.S. Practices Improve Collections

From eligibility checks and coding review to claim submission, payment posting, denials and A/R follow-up, SkyLine MB helps your practice manage each claim through payment or documented resolution.

FREE BILLING AUDIT

See where your revenue is slipping

Tell us about your practice. A billing specialist will contact you to discuss your claims, denials and A/R review — no obligation.

Please do not include patient information. By submitting, you ask us to contact you about your enquiry. Read our Privacy Policy.

24–48 hrs

Clean-claim submission

1 manager

Dedicated to your practice

Monthly

KPI & A/R review

No lock-in

Flexible agreement

Every claim tracked to a documented outcome

OVERVIEW

What Are Medical Billing Services?

Medical billing services manage the financial steps between a healthcare practice, its patients and insurers. The work includes verifying insurance, reviewing codes, submitting claims, posting payments and following up on denials and unpaid balances.

SkyLine MB supports U.S. practices with the billing workflow, a dedicated contact and monthly reporting. Your team retains clinical decisions and documentation; we coordinate the billing tasks agreed in your service scope.

Who it's for

Physicians, groups, clinics and ASCs in all 50 states

What's included

Eligibility, coding, claims, posting, denials and A/R

How it's priced

Usually a % of collections — quoted after a free audit

Time to go live

Plan around 2–4 weeks; access and payer readiness affect timing

THE CHALLENGE

Why Medical Billing Has Become Harder for U.S. Practices

Physicians are expected to deliver care, keep up with payer rules, follow new code sets and stay compliant — all at once.

41%

of surveyed providers reported claim-denial rates of 10% or more.

prior authorizations per physician, per week — about 13 hours of combined physician and staff time.

Rising claim denials

Eligibility gaps, missing authorizations and coding errors push denial rates up and cash flow down.

Delayed insurance payments

Claims stall in payer queues when no one is checking status or answering requests for records.

Changing payer requirements

CMS rules, payer policies and medical-necessity edits change every year — often every quarter.

Coding & documentation gaps

ICD-10-CM updates every October and CPT changes every January leave room for costly mistakes.

Limited in-house billing staff

Billers are hard to hire and train — and every resignation stalls follow-up.

Growing A/R balances

Unworked claims age past 90 days and quietly become write-offs.

Most revenue problems start long before a denial. They begin with wrong eligibility data, incomplete documentation or missed follow-up — which is why our workflow fixes the front end first.

WHAT'S INCLUDED

Complete Medical Billing Services We Provide

Build your service scope around the work your practice needs, from front-end checks to follow-up. We confirm responsibilities, coding coverage and any separately quoted work before you start.

Eligibility Verification

Coverage, copays, deductibles and referral needs confirmed before every visit.

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Prior Authorization

Payer-specific authorization requests prepared and tracked, with approval status communicated to your team.

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Medical Coding

Certified coders validate ICD-10-CM, CPT, HCPCS and modifiers.

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Charge Entry & Submission

Charges captured from your EHR, checked and submitted once complete documentation and approvals are available.

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Claim Scrubbing

Payer-specific and NCCI edits help flag errors before submission.

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Payment Posting

ERA/EOB payments posted and checked against your contracted rates.

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Denial Management

Root-cause analysis, corrected claims and written appeals.

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A/R Follow-Up

Aging claims worked by payer and dollar value until resolved.

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Also available:

HOW IT WORKS

Our Medical Billing Process, Step by Step

Six connected stages, with checks and follow-up adapted to your specialty and payers. During onboarding, we agree system access, documentation handoffs, open A/R responsibilities and the go-live plan.

STEP 01

Patient intake & eligibility

Demographics, insurance and benefits verified before the appointment.

STEP 02

Coding & charge entry

Codes and documentation reviewed, with questions returned to your clinical team before charges are released.

STEP 03

Claim scrubbing

Payer-specific and NCCI edits applied to every claim before release.

STEP 04

Electronic submission

Submission targeted within 24–48 hours after complete charge information and required approvals are received.

STEP 05

Payment posting

ERAs and EOBs posted and reconciled against your fee schedule.

STEP 06

Denials, appeals & A/R

Open claims followed through payment, appeal or another documented outcome, with progress reviewed monthly.

IN-HOUSE VS. OUTSOURCED

Outsourced Medical Billing Services vs. In-House Billing

A side-by-side look at what it takes to run billing well.

Compare staffing, scope and oversight before choosing a billing model
What matters	In-house billing	SkyLine MB (outsourced)
Staff & cost	Salaries, benefits, training and management	Agreed fee for the contracted billing scope
Coverage	Set by your staffing and backup arrangements	Coverage and escalation agreed with your billing contact
Coding expertise	Developed through hiring, training or coding support	Coding review and specialty requirements agreed in scope
Payer updates	Your team monitors and applies relevant changes	Relevant payer edits reviewed within the billing workflow
Denial follow-up	Managed by internal staff and available capacity	Assigned follow-up, appeals and reason-code reporting
Reporting	Configured through your practice systems	Monthly KPI and A/R review with your billing contact
Technology	Your team selects and manages its tools	Workflow assessed around your existing EHR and tools
Security responsibilities	Practice safeguards and staff access controls	Shared responsibilities, a BAA and agreed access controls

In-house billing can work well for some practices. But as claim volume, payer mix and specialties grow, many providers choose outsourced medical billing services to get specialist knowledge without carrying the full cost of a billing department. Small practices can see our medical billing services for small practices.

CODING & CLAIM ACCURACY

Medical Billing Code Sets We Review

Diagnosis codes, service codes and modifiers each have a different role in a claim. Our coding review checks the documented encounter against the relevant code set and payer requirements.

Code systems, illustrative examples and the checks that matter
Code set	Example	What we check
ICD-10-CM	E11.9 Type 2 diabetes without documented complications	Diagnosis specificity and support in the clinical record.
CPT / HCPCS Level I	99213 An established-patient office or outpatient E/M service	Service level, documentation and the applicable selection criteria.
HCPCS Level II	E0601 A continuous positive airway pressure (CPAP) device	Equipment or supply coding, units and payer coverage requirements.
Modifiers	25 A separately identifiable E/M service in appropriate same-day circumstances	Whether the record supports the modifier and relevant payer rules.

These independent examples are educational, not a recommended claim combination. Final code selection depends on the clinical record, date of service and current payer rules. CPT is a registered trademark of the American Medical Association.

References: CMS code sets · CDC diagnosis example · CMS E/M example · CMS equipment example · CMS modifier guidance

Explore Medical Coding Services →

PRICING

How Much Do Medical Billing Services Cost?

Most medical billing companies charge in one of three ways. The right model depends on your specialty, claim volume and payer mix.

Percentage of collections

The most common model. You pay a share of what is actually collected, so your billing partner earns more only when you do.

Quoted as a percentage of collections

Best for most practices

Per-claim fee

A fee for each claim within an agreed scope. Confirm whether corrections, appeals and follow-up are included before comparing quotes.

Rate depends on claim complexity

Best for high-volume, low-complexity claims

Flat monthly fee

A fixed monthly price for an agreed scope and claim volume. Easy to budget; scope must be clear.

Varies by providers and scope

Best for stable, predictable volume

HOW SKYLINE MB PRICES

One clear rate, quoted after a free audit

Your quote reflects specialty, claim volume, payer mix and the work required. We confirm core billing tasks, legacy A/R, coding, patient statements, software costs and any separately priced services in writing before you start.

TRANSPARENT REPORTING

The Medical Billing KPIs We Report Every Month

Monthly reporting makes billing performance easier to assess. We agree definitions, reporting periods and practice-specific targets against your baseline.

Clean claim rate

Acceptance

Initial claims accepted without correction ÷ initial claims submitted. Clearinghouse rejections are reported separately from payer denials.

Denial rate

Payer denials

Claims denied ÷ claims adjudicated in the reporting period. We separate initial denials from appeal outcomes and track reason codes.

Days in A/R

A/R ÷ charges

Total accounts receivable ÷ average daily gross charges over the agreed lookback period. This measures outstanding A/R, not individual claim payment time.

Net collection rate

Collectible revenue

Payments ÷ collectible charges after contractual adjustments, using an agreed reporting basis that accounts for payment timing.

A/R over 90 days

Aging balances

Outstanding balances aged over 90 days ÷ total A/R. The report states the aging basis and separates payer and patient balances.

First-pass resolution

Paid first pass

Initial claims paid without correction, resubmission or appeal ÷ initial claims resolved in the agreed reporting cohort.

Definitions and reporting periods are agreed during onboarding. Targets are set for your specialty, payer mix and starting position; no collection or payment outcome is guaranteed.

SPECIALTIES

Medical Billing for 20+ Specialties

Every specialty has its own codes, modifiers and payer rules. Pick yours to see how we bill it.

EHR & PM SYSTEMS

Works Inside Your Current EHR

We assess your current EHR and practice-management workflow first, then agree access and handoffs with your team.

Using another system? Tell us which platform you use so we can confirm compatibility and access requirements.

TECHNOLOGY

AI-Assisted Medical Billing With Human Review

Automation catches patterns and repetitive errors fast. But billing decisions still need judgment — clinical context, payer interpretation and coding guidelines. So every flag our tools raise is checked by an experienced biller.

COMPLIANCE & SECURITY

HIPAA-Compliant Medical Billing Services

HIPAA sets national standards for protecting patient health information — and it applies to billing partners too. We sign a Business Associate Agreement before we touch any system.

FREE MEDICAL BILLING AUDIT

Not sure where your revenue is slipping?

Your free billing audit focuses on claims, denial patterns and A/R aging. We discuss the findings, identify priority actions and outline the next steps for your practice.

What happens next: send your practice details, speak with a billing specialist, then agree a secure way to provide any records needed for the review. Do not send patient records through this enquiry form.

CLIENT STORIES

What Practices Say About SkyLine MB

Independent practices, specialty groups and clinics trust us with the work that keeps revenue moving.

Our denials used to sit for weeks. Now every denial has an owner, a reason code and a next step — and we see it all in one monthly review. It's the first time billing hasn't felt like a black box.

Therapy billing has so many visit limits and modifier rules. The team caught authorization gaps before they turned into denials, and our front desk finally stopped chasing payers.

Switching billing partners scared us, but onboarding was organized from day one. They worked inside our existing EHR, so my staff didn't have to learn anything new.

Telehealth codes, payer-specific policies, credentialing — they handled all of it. Having one billing manager who actually knows our practice makes a real difference.

We get clear answers on why a claim was underpaid and what's being done about it. The monthly KPI call is something our physicians now look forward to.

High visit volume means small errors add up fast. Clean claims go out quickly and the A/R follow-up is consistent — no more old balances quietly aging out.

FAQ

Frequently Asked Questions About Medical Billing Services

Straight answers to what practices ask before choosing a billing partner.

Still have a question?

Talk to a billing specialist — no sales pressure.

What are medical billing services?

Medical billing services manage the financial process between healthcare providers, patients and insurance companies. They include insurance verification, coding review, charge entry, claim submission, payment posting, denial follow-up and accounts receivable management.

What does a medical billing company do?

A medical billing company reviews charge information, submits claims, posts payments, follows up on denials and unpaid balances, and reports on billing performance. Claims are tracked through payment or another documented resolution.

How much do medical billing services cost?

Fees may be based on a percentage of collections, a per-claim rate or a fixed monthly scope. Your specialty, volume, payer mix and follow-up needs affect the quote. SkyLine MB confirms the rate, inclusions and any separately priced services after a free billing audit.

Why do practices outsource medical billing?

To get specialist billing knowledge, steadier cash flow and less admin work without hiring, training and keeping an in-house team. Outsourcing also covers gaps when staff are out or leave.

What is included in outsourced medical billing services?

Your agreed scope can include eligibility checks, authorization support, coding review, charge entry, claim scrubbing and submission, payment posting, denial follow-up, A/R and reporting. We clarify legacy A/R, full encounter coding, patient statements and any separate charges in writing before work starts.

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