Primary care billing
Primary care billing,
without the denials.
Primary care runs on volume. Thirty visits a day means thirty eligibility checks, thirty sets of codes and thirty chances to miss revenue. We keep the line moving and catch the revenue that high volume hides.
What makes it hard
Where primary care revenue gets lost.
Preventive and problem visits together
Treating a problem during a preventive visit can be billed separately with modifier 25, but only when the documentation supports a separate, significant service.
Wellness visit rules
Medicare's Annual Wellness Visit (G0438 initial, G0439 subsequent) is different from a preventive physical and has frequency limits.
Care management programs
Chronic care management, transitional care and remote monitoring codes pay well but need consent, time tracking and specific documentation.
Eligibility at scale
Plan changes are common in primary care populations. Checking every patient before every visit is the only way to stop eligibility denials.
How we handle it
Checks built into every claim.
Our team and the GetMax platform apply these checks before claims go out, not after the denial comes back.
- Eligibility checked for every scheduled patient, every day
- Preventive and problem-oriented services coded and separated correctly
- Wellness visit frequency checked before the visit is booked
- Care management time and consent tracked so those codes can be billed
Frequently asked
Questions we hear a lot.
Can we bill a preventive visit and a sick visit on the same day?
Yes, when a significant, separately identifiable problem is addressed. The problem-oriented visit is billed with modifier 25 and the documentation must support it.
What is the difference between G0438 and G0439?
G0438 is the initial Medicare Annual Wellness Visit and G0439 is each subsequent one. Neither is the same as a routine preventive physical, which Medicare does not cover.
Keep reading
Other specialties.
Specialty
Behavioral & mental health
Billing for therapists, psychiatrists and counseling groups: time-based psychotherapy codes, telehealth, authorizations and carve-out payers, handled.
Learn more →Specialty
Physical therapy
PT billing that gets timed units, the 8-minute rule, KX thresholds, plan-of-care certification and visit limits right, so therapy claims get paid.
Learn more →Specialty
Chiropractic
Chiropractic billing for Medicare and commercial plans: spinal manipulation codes, AT and GA modifiers, ABNs, documentation and visit limits handled.
Learn more →Let's look at your primary care numbers.
Tell us your payer mix and your biggest headache. We will show you what we would change.