Specialty billing / Family Practice
Family practice earns thin margins on high volume, which makes small billing errors expensive at scale. The recurring problems are structural: preventive visits that also address chronic problems, wellness visits confused with physicals, immunization administration billed incompletely, and care management services delivered but never reported.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
A wellness visit that also addresses uncontrolled diabetes supports both a preventive code and a problem-oriented visit. Most practices bill only one, and the second visit needs modifier 25 plus a note that clearly separates the two conversations.
Medicare covers an annual wellness visit, which is a specific set of assessments, and does not cover a routine physical. Practices that use these terms interchangeably either bill a non-covered service or miss the covered one entirely.
Each vaccine has a product code and an administration code, and multi-component vaccines in children carry additional administration units. Practices that bill only the product lose the administration fee on every dose given.
Staff already coordinate refills, referrals and between-visit calls for complex patients. Without time logs, a documented care plan and consent on file, that work generates no revenue even though the service requirements were substantially met.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Yes, when the physician addresses a problem that goes beyond the preventive service and documents it separately. Append modifier 25 to the problem visit. The note should read as two distinct pieces of work. Managing a stable chronic condition briefly during a physical usually does not meet the threshold.
The Medicare annual wellness visit is a prevention planning service built around a health risk assessment, a personalized prevention plan, and a review of risk factors and cognitive status. A routine physical is a head-to-toe examination and is not a Medicare benefit. Only the wellness visit is covered, and only if its elements are documented.
It requires an eligible patient with two or more chronic conditions, documented consent, a comprehensive care plan in the record, and a log of qualifying clinical staff time in the calendar month. Time is billed once monthly against the threshold met. Most practices already do the work and simply lack the documentation structure.
Almost always because the diagnosis code sent describes a condition rather than a screening. A screening colonoscopy or lipid panel ordered on an asymptomatic patient needs a screening diagnosis code. Sending a diagnostic code converts a covered preventive benefit into a service subject to deductible and coinsurance.
WNL RCM files claims within 48 hours of receiving documentation and targets payment within 30 days. Clean submission is most of it, but so is working the denial the same week it arrives rather than at month end, when the timely filing window for a corrected claim has already narrowed.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
