Specialty billing · Adult Primary Care
No single six-figure claim. A hundred small increments a week.
Primary care billing services from 247 Medical Billing Services keep family and internal-medicine practices paid in full across Medicare, Medicaid, Medicare Advantage, and commercial payers — every office visit, wellness exam, and care-management minute captured. You get a dedicated account manager, a free 360° reporting dashboard, and HIPAA and SOC 2 Type II security, backed by certified coders running your revenue cycle since 2005.
Adult primary care doesn't lose money the way a surgical practice does. There is no single six-figure claim to fight over — instead there are a hundred small increments a week, and any one of them is easy to drop.
The continuity add-on nobody appended. The annual wellness visit that adjudicated like an ordinary problem visit. The chronic-care minutes that were delivered but never logged. The diagnosis that quietly fell off the problem list and pulled the panel's risk score down with it.
Add those up over a year and they dwarf the occasional large denial a specialist chases. That is the trap most billing companies walk into: they treat a primary-care encounter as one clean office visit to push through a clearinghouse, when in reality it is a stack of overlapping, rule-bound revenue streams that each have to be recognized, coded, and defended on their own terms.
Getting a family- or internal-medicine claim merely paid is easy. Getting it paid what it earned is the discipline, and it's the whole reason a practice hands the work to a primary care billing services company rather than a generalist.
We run the complete revenue cycle for independent primary care — family medicine, internal medicine, nurse-practitioner-led clinics, direct-primary-care memberships, and value-based and accountable-care practices where the panel, not the visit count, drives the money. The payment model is treated as one connected system: office and outpatient evaluation and management, the continuity complexity add-on, preventive versus problem visits, the between-visit care-management stack, and the risk-adjustment coding behind every value-based contract.
We manage each revenue layer of a modern primary-care practice so nothing eligible goes unbilled and nothing billed goes unsupported. Every unit, modifier, and time threshold is worked to its own rulebook — no add-on assumed, none rounded away:
| Preventive service | Which payer | Routine physical? | Same-day problem |
|---|---|---|---|
| Commercial annual physical | COMMERCIAL | COVERED | MODIFIER 25 |
| Medicare Annual Wellness Visit | MEDICARE | NOT A PHYSICAL | MODIFIER 25 |
| Medicare initial preventive exam | MEDICARE | NOT A PHYSICAL | MODIFIER 25 |
| Routine physical billed to Medicare | MEDICARE | NOT REIMBURSED | DENIED OUTRIGHT |
A commercial annual physical, a Medicare Annual Wellness Visit, and a Medicare initial preventive exam are three separate services with three separate rule sets, and Medicare does not reimburse a routine physical at all. Bill the wrong one, or fold a same-day problem in without the correct modifier, and the encounter denies or pays a fraction of its worth.
| Revenue layer | What it is | What we manage |
|---|---|---|
| Office E/M + complexity add-on | Office/outpatient visits (99202–99215) leveled on decision-making or total time, plus the continuity add-on (G2211) | Correct level on every visit and the add-on appended wherever continuity of care supports it |
| Preventive & wellness visits | Commercial physicals, the Medicare Annual Wellness Visit (G0438/G0439), and the initial preventive exam (G0402) | The right visit for the right payer, with modifier 25 applied so a same-day problem also pays |
| Care-management stack | Chronic (99490), principal, and transitional care management, plus remote monitoring and advance care planning | Consent, time tracking, and one non-duplicated care-management home so every eligible minute is captured and defensible |
| Risk adjustment (HCC/RAF) | Diagnoses mapped to condition categories that scale value-based payment | Annual re-capture with Monitor/Evaluate/Assess/Treat support and an honest two-way review under the current model transition |
| Incident-to & supervision | NP/PA services billed under the physician at the full rate vs. the reduced mid-level rate | Supervision and established-plan rules confirmed before the claim so the full-rate billing holds |
The continuity complexity add-on rewards a physician for being the patient's single ongoing source of care. It is documented on nearly every longitudinal visit yet billed on almost none — pure earned revenue left behind.
Chronic care management, principal care management, transitional care after a discharge, remote patient and therapeutic monitoring, and advance care planning are all billable — but only with patient consent, real time tracking, one non-duplicated care-management "home," and no overlap.
Under risk adjustment, the conditions you document and re-capture each year drive the score that scales Medicare Advantage and accountable-care revenue. Undercode and you're underpaid; document without clinical support and you invite a recoupment.
Annual re-capture is not a one-way exercise in adding codes. We run it both ways, with Monitor/Evaluate/Assess/Treat documentation behind every condition that stays on the list.
Chronic conditions documented and re-captured each year, so the score reflects the burden you actually manage instead of decaying off the list.
Anything no longer clinically supported comes off, because documenting without support is what invites a recoupment.
The case to outsource primary care billing services is different from almost any other specialty, and it comes down to breadth. A single family or internal-medicine physician has to bill correctly across E/M leveling, preventive rules, five or six care-management programs, incident-to supervision, and annual risk adjustment — a wider rulebook than most sub-specialists ever touch.
Expecting one in-house biller to stay current on all of it, absorb every quarterly payer change, and cover vacations and turnover is where the leaks start. One person cannot be an expert in everything primary care bills, and the codes that get skipped are always the specialized ones that pay.
Handing the work to a dedicated team changes the math. Certified coders who see primary-care claims all day already know that G2211 belongs on the longitudinal visit, that the Medicare wellness visit is not a physical, and that a care-management program without a consent trail is a recoupment waiting to happen. Costs move from a fixed salary — with its recruiting, training, and coverage risk — to a transaction-based fee that rises only when your revenue does. For an independent practice, professional primary care billing services usually recover more than they cost in the first few cycles, simply by capturing the increments an overstretched in-house biller never had time to chase.
Everything it takes to move a primary-care encounter from the note to paid — run by one certified team sharing one record, instead of split across vendors that hand your claims back and forth:
Coverage, plan type, and preventive-benefit rules confirmed before the visit, so nothing denies on a lapsed policy or a non-covered routine physical.
Visits leveled correctly, the G2211 continuity add-on captured, wellness visits kept distinct from physicals, and every care-management program coded with the consent and time documentation behind it.
Annual diagnosis re-capture with full clinical support, a two-way review that adds and retires conditions honestly, and documentation that survives a validation audit while your risk score reflects your real patient panel.
Encounters reconciled, scrubbed, and filed within 24 hours so complexity, wellness, and care-management revenue all clear on the first pass.
Every denial worked to root cause, from bundling edits to non-covered wellness visits, and appealed inside the payer's window.
Physicians, nurse practitioners, and physician assistants enrolled and re-credentialed so nothing rejects on provider eligibility or supervision setup.
Prefer to keep primary care billing and coding services under one roof? That's exactly the model — certified coders and billers on the same team, sharing the same record, instead of your claims changing hands between companies. It's also why we operate as a full-service revenue cycle management partner rather than a claims processor.
Revenue review
A certified primary-care specialist puts a dollar figure on the complexity revenue, wellness visits, care-management minutes, and undercoded diagnoses your practice is leaving behind.
A primary care billing specialist will reach out within one business day.
A primary care billing specialist will reach out within one business day.
Choosing us isn't hiring a general biller who happens to accept primary-care claims. It's partnering with a team that already knows where family- and internal-medicine revenue leaks and, more to the point, how to stop it before the claim ever goes out:
The continuity add-on goes on every eligible visit, so you stop giving away revenue you're entitled to on encounters you already document in full.
Preventive and Annual Wellness Visits are coded to the correct payer rule, and modifier 25 is applied when a problem is addressed the same day, so both services pay instead of one bundling into the other.
We stand up and run your care-management programs with the consent, time logs, and single-home discipline that keep them payable — often a five-figure line item practices had left entirely untouched.
Diagnoses are re-captured each year with documentation that supports them, so value-based payment reflects your panel without exposing you to a recoupment.
A named account manager owns your account and a live 360° dashboard shows every claim, denial, and dollar — with no long-term lock-in holding you in place.
Typically see these numbers, month after month rather than just in the first quarter:
A generalist learns primary care on your claims. We arrive already fluent in it — and the difference lands on the remittance:
Most primary-care losses trace back to the same handful of failure points. We close each one at the front end, before it becomes a denial, a downcode, or a recoupment:
Routine physical (99381–99397) billed to Medicare
Non-covered denial — Medicare pays no routine physical
We bill the Medicare AWV (G0438/G0439) or IPPE (G0402) instead, matched to the patient's history
AWV + problem visit same day without modifier 25
Bundling denial — one service pays, the other is lost
We append modifier 25 to the E/M so both the wellness visit and the problem visit pay
Continuity complexity add-on (G2211) omitted
Lost complexity revenue on every eligible longitudinal visit
We append G2211 wherever continuity of care supports it
Care management (99490 and related) without consent or time
CCM/PCM/RPM denial or recoupment
We document consent, log time, and keep a single non-duplicated care-management home
HCC diagnosis unsupported by MEAT or not re-captured
RADV recoupment plus a depressed RAF and underpayment
We re-capture annually with Monitor/Evaluate/Assess/Treat support and a two-way review
Incident-to billed without direct physician supervision
Recoupment to the reduced mid-level rate
We confirm supervision and the established plan before billing at the full rate
Every one of these is preventable before submission rather than argued after the fact. Request a revenue review and we'll show you which of them is hitting your remits right now.
Primary care isn't one setting, and the rules shift with each. We bill every model to the detail it demands:
High-volume office and outpatient visits where correct leveling and the continuity add-on decide whether the practice is paid its true value.
What decides the moneyLevelling and the continuity add-on
Scope-of-practice and incident-to billing done right, plus the membership and hybrid models a generalist rarely understands.
What decides the moneySupervision rules and the membership model
Multi-condition patients whose chronic disease burden only pays correctly when the diagnoses are captured to their real depth every year.
What decides the moneyAnnual re-capture to real depth
Risk-adjustment coding, annual re-capture, and quality reporting run as a discipline, so shared-savings and capitated revenue match the panel you actually manage.
What decides the moneyThe risk score behind the contract
Programs stood up, documented, and billed from day one so a new revenue stream doesn't stall on compliance.
What decides the moneyConsent, time logs and a single home
Changing billers shouldn't mean a gap in cash flow, and with us it doesn't.
We work inside your existing electronic health record and practice-management system, so nobody relearns a platform.
Credentialing and payer-enrollment review run in parallel while your claims keep going out the door, a named account manager leads the transition from day one, and most primary care practices are fully live within a few weeks.
As you add providers, locations, or new care-management lines, the billing scales with you instead of becoming the thing you outgrow.
The denial drop, the recovered complexity revenue, and the faster A/R show up in the first cycles — not a quarter later.
Stop leaking the small increments that quietly add up to more than any large denial.
An adult family or internal-medicine practice earns across many rule-bound streams — leveled office visits, a continuity add-on, preventive versus problem encounters, five or six care-management programs, and the risk-adjustment coding behind every value-based contract — and each is easy to drop when the encounter is treated as one office visit pushed through a clearinghouse. We build the revenue cycle to recognize every layer at the point of care: the right visit level, the add-on where continuity supports it, the wellness visit kept distinct from the physical, and the between-visit work logged so it stays payable. That is what primary care medical billing needs to be paid what it earned, not merely paid — and it shows up as recovered complexity revenue in the first cycles. Want it proven on your own remits?
The primary care billing services provider you want understands the full breadth of what your practice bills — and 247MBS answers in specifics on every piece that decides payment.
What changes hands
Outsource primary care billing to 247MBS and the widest rulebook in medicine stops resting on one overstretched biller. The ongoing payoff is steady: denials down by up to 40%, a first-pass clean-claim rate around 99%, net collections near 99%, days in A/R under 25, and up to 90% of worked denials overturned.
Visits are levelled and the continuity add-on captured, care-management minutes billed, and risk-adjustment coding re-captured each year to survive a validation audit. Outsourcing primary care billing services removes the single-point-of-failure risk of one in-house biller carrying every rule alone, and swaps a fixed salary for a transaction-based fee that rises only when your revenue does.
Because primary care billing services outsourcing puts expertise across every stream to work at once, the specialized codes a generalist skips finally get billed — and you watch it all on a live dashboard, no black box. See what handing it off recovers or call +1 888-502-0537.
NO SPOFNo one biller carrying every rule aloneALIGNEDA fee that rises only when your revenue doesNO BOXEvery claim, denial and dollar on a live dashboardWhether you're a solo family physician, an NP-led clinic, an internist with a complex panel, or a value-based practice, our primary care billing services protect every layer of your revenue — the visit, the complexity add-on, the wellness exam, the care-management minute, and the risk score behind your value-based payment. Work with a primary care billing services company that treats E/M leveling, preventive rules, care management, and risk adjustment as routine, and put the revenue you're leaving on the table back where it belongs.
Prefer email? sales@247medicalbillingservices.com