Medical Billing & Coding Process
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Medical billing and coding services only work when the process is airtight. This page explains our medical billing process steps—from eligibility to payment posting—so you know exactly how Rhino MDs builds clean claims, reduces denials, and keeps cash flow moving for practices across the United States. If you’re comparing outsourced billing and coding providers, this walkthrough will show you how our HIPAA-compliant medical billing workflow fits into your EHR, clearinghouse, and payer mix.
Need the service overview instead? See Medical Billing & Coding Services.
What this covers
We manage the complete medical billing workflow:
- Eligibility & benefits verification
- Charge capture review and documentation checks
- Coding (CPT/HCPCS, ICD-10) with payer-specific rules
- Edits, claim scrubbing, and pre-submission QA
- Electronic submission (EDI), payment posting, and denial management
- AR follow-up, appeals, and continuous reporting
All work is performed in a HIPAA-compliant environment with role-based access and audit logs.
What this covers
We manage the complete medical billing workflow
Eligibility & benefits verification
Charge capture review and documentation checks
Coding (CPT/HCPCS, ICD-10) with payer-specific rules
Edits, claim scrubbing, and pre-submission QA
Electronic submission (EDI), payment posting, and denial management
By outsourcing, healthcare providers gain a financial partner who is just as invested in their revenue as they are in patient health.
Our Services
Step 1: Intake & documentation (front-end accuracy)
Most issues that slow down revenue start here, so we keep intake tight:
- Eligibility and benefits are verified before the visit when possible (plan status, deductible, co-pay, referral requirements).
- Charge capture and the superbill are checked for completeness—units, POS, time, and attachments.
- Medical necessity & ICD-10 specificity (laterality, encounter type, causation) are validated so payer policies are met.
Example: For weight-management counseling, we confirm Z71.3 is supported in the note and that counseling/E&M time rules are met. Doing this up front prevents back-and-forth later.
Step 2: Coding & compliance (CPT/HCPCS + ICD-10)
Our certified coders focus on accuracy, not guesswork. We align with the latest CPT/HCPCS and ICD-10 updates and your specialty needs.
- E/M levels: chosen by documentation or time—whichever is appropriate.
- ICD-10 detail: etiology, laterality, and episode of care when relevant.
- Modifiers: correct use of 25, 59, and telehealth billing modifiers (95/GT) by payer; POS 02/10 as required.
- Bundling edits: NCCI rules are addressed before claims leave the system.
Want a quick check on difficult charts? Request a free coding audit, and we’ll review a sample encounter with your team.
Step 3: Edits, scrub & pre-submission QA (clean claim process)
Every claim passes three quality gates to raise first-pass approval:
- Rules engine: NCCI edits, payer quirks, enrollment/NPI validation, attachment requirements.
- Clearinghouse validation: formatting and enrollment errors caught before payers see them.
- Human review for high-value/high-risk claims by a senior coder (codes ↔ diagnoses linkage, required documentation, correct modifiers).
We maintain a simple, clean claim checklist—demographics, coverage match, CPT↔ICD logic, POS, units, and supporting documentation—so the same mistakes don’t repeat.
Step 4: Submission, payment posting & AR follow-up
Claims are sent via secure EDI to payers nationwide. We post ERAs/EOBs promptly and review exceptions the same day.
After posting, our denial management team:
- Categorizes denials (e.g., CO-97, CO-50, PR-204) for trend visibility.
- Chooses the next action—correct and resubmit, or appeal with documentation.
- Follows clear SLAs that keep balances from aging (charge entry, payment posting, and denial follow-up windows).
Sample KPI table (replace with your real figures)
Metric | Typical baseline | Target with our process |
First-pass approvals | 90–93% | [your target]% |
AR days | 35–45 | [your target] |
Overall denial rate | 7–10% | [your target]% |
Appeal win rate | 50–60% | [your target]% |
Want deeper tracking? Visit Reporting & Analytics for our KPI dashboard.
Step 5: Quality loop & reporting (revenue cycle management)
We treat this page as part of revenue cycle management (RCM), not a one-off task. Every month you receive:
- AR aging with next actions by bucket (0–30, 31–60, 61–90, 90+).
- Top denial reasons and what changed in our process to prevent repeats.
- Coding/documentation guidance your clinicians will actually read.
- Practice-level summary you can share with stakeholders.
These reports turn a static medical billing process into a living system that keeps getting cleaner.
Specialty & telehealth notes (nationwide coverage)
We support providers across the USA with specialty-specific rules:
Behavioral health/ABA
time-based therapy codes, 90837 vs 90834, prior auth and plan limits.
Cardiology & orthopedics
global periods, device HCPCS, and bundling traps
Pediatrics
vaccine admin with product codes, age-specific ICD-10
Telehealth
telehealth billing modifiers (95/GT), POS 02/10, synchronous documentation, and payer variations across states.
For multi-state groups, we set payer rules per locale so telehealth and Medicaid differences don’t derail claims. See specialty pages starting with Behavioral Health Billing.
Why practices choose Rhino MDs (nationwide)
- Process clarity: You can see each step and who owns it.
- EHR flexibility: We work with Athena, Kareo, AdvancedMD, DrChrono, Office Ally, and other major platforms.
- Scalable coverage: From solo providers to multi-location groups across the United States.
- Security first: HIPAA-compliant medical billing with BAA and role-based access.
- Measurable results: Clean claims up, rework down, cash flow steadier.
Next steps
- Compare plans and inclusions on Pricing.
- Want a quick assessment of your medical billing workflow? Get a free billing & coding audit via Contact Us.
- Already losing time to denials? See Denial & AR Management.
Frequently Asked Questions
A clean claim passes payer and clearinghouse edits on the first submission. We use rules, clearinghouse checks, and a quick human review on high-risk claims to keep approvals high.
Yes. We apply the correct telehealth billing modifiers (95/GT), POS 02 or 10, and payer-specific rules so multi-state providers stay compliant.
We regularly work with Athena, Kareo, AdvancedMD, DrChrono, and Office Ally, and can adapt to most systems used by US practices.
If you’re already credentialed, onboarding typically begins within a few business days. For new enrollments, our Provider Credentialing team handles CAQH and payer setup.
Typical SLAs: charge entry in 24–48 hours, payment posting in ~48 hours, and denial follow-up within ~72 hours. We’ll align these with your practice needs.
Get Started with RhinoMDs Today
Running a practice is tough—but billing doesn’t have to be. RhinoMDs is here to help you increase revenue, reduce denials, and achieve peace of mind.
Address
12600 Rolater Rd #120, Frisco, TX 75035
info@rhinomds.com
Our number
+1 (469) 382-6157
Contact
Get in touch
RhinoMDs is a company dedicated to ensuring our health care providers are covered in any process and the entire process.
Address
12600 Rolater Rd #120, Frisco, TX 75035
Our number
+1 (469) 382-6157
info@rhinomds.com