Medical Billing Services for Small Practices
Medical billing services offered to small practices are revenue cycle management for small doctors’ practices and groups of physicians ranging from one to ten. There is only one crew responsible for the entire cycle, which starts with eligibility verification and coding and goes all the way through the denials, patients’ balances, and receivables. Small practice has to follow the same payers’ requirements as the hospital does, but lacks the capability for billing. UControl will fill that void and allow doctors to deal with patients rather than with the payers and the owner to avoid being on the phone with the latter.
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Why Billing Is Harder For A Small Practice
Even a small practice is bound by the same rules as a hospital system. It must adhere to the same payer edits, the same coding guidelines, the same deadlines for claims submission, and the same medical necessity review requirements, regardless whether it is just one physician or a multi-bed hospital. But everything behind the claim will be different.
Hospitals have a separate department devoted to handling billing and payments. There are coders sitting in one place, payment posters in another, an appeals division, and compliance officers monitoring the process. Small practices usually employ just one biller, or a receptionist doing dual duties at once, or an owner who balances claims after closing office hours. Since the rules are not adjusted to a smaller number of employees, the burden of work falls onto those who are already busy with their primary tasks.
The result is risk aggregation. In case of failure in handling the claims from the side of a big company the costs are spread among multiple providers and huge cash reserves. The mistake of a two-physician practice will have an immediate impact on the income received by its owners. Just one denied claim, missed authorization, or expired enrollment becomes noticeable.
That is the challenge which our solution addresses. Not because small practice billing is complicated, but because it is hospital-level complicated with less staffing and the owner directly responsible for any shortfall. It’s not more software or working harder by the front desk staff. It’s a team that takes responsibility for the result.
Hospital-Grade Billing, On a Solo Practice's Staff
It makes no difference how big the entity is, a small practice is subjected to the same laws as the hospital system. Payer edits, coding laws, prior authorizations, and timely filing limits apply equally well to either a five hundred-bed system or a solo practitioner. Complexity is consistent. What varies greatly is the party backing the claim.
The hospital has a billing department. Coders occupy one position, payers occupy another, denial specialists do all they can for denied cases, and there is even a compliance officer keeping watch over the whole department. In a small practice there is usually only one biller. Sometimes he sits at the front desk, sharing billing responsibilities with registration and phones. Sometimes it is the doctor himself, who reviews remittance advice long after his last patient has left. It doesn’t get any easier simply because of fewer people involved.
Consequently, risk becomes concentrated. Mistakes of a big system mean the loss is distributed among hundreds of physicians and a large cash flow. For a two-doctor office it means they will be paid that month less than the loss. Denial of a high-reimbursed claim, failure to obtain prior authorization, lapse of the insurance company membership between renewals, and the gap is immediate and personal.
None of that means there is no hope for your small practice to be billing efficiently. It simply means that the solution to your problem cannot be an additional software access or a late-working receptionist. It should be a team dedicated exclusively to the revenue cycle.
What Counts As A Small Practice
Small Practice is an independent physician practice of one to ten providers that operates without the multiple-tiered billing department that hospitals have in their employ. Small is defined by organizational structure, not medical specialty; if billing is handled by one or two individuals as opposed to a department, the organization qualifies regardless of the type of medicine being practiced.
Solo physicians
Provider operating with financial and medical risk on the same shoulders.
Independent groups
Group of two to ten providers splitting overhead costs, but rarely a dedicated billing department.
Start-up practices
Practice owners creating the billing process from scratch.
Low volume and part-time
Practices in which claims volume doesn't warrant hiring a salaried biller.
Rural clinics
Practices in which it is difficult and expensive to find an experienced coder locally.
Growth practices
Groups growing with new physicians but no additional billing capacity.
What Our Small Practice Billing Service Includes
One team takes responsibility for the process from the scheduling of the patient all the way through reconciliation of the last dollar.Revenue cycle is an end-to-end process, where each step covers a gap that might otherwise remain uncovered by the next. There are two steps that are particularly important for a small practice, compared to a hospital, and are noted below.
Eligibility & benefits verification
Coverage, type of plan, and cost sharing are verified prior to the visit so that lapsed coverage or wrong plan is identified at the time when the claim can still be revised rather than denied weeks after.
Prior authorization
Services requiring prior authorization are obtained prior to submission to remove the most prevalent front-end cause for rejected claim.
Coding review & charge entry
Charges are entered based on the documentation and reviewed to ensure that the claim is accurate and will survive payer editing and medical necessity review.
Claim scrubbing
Coverage, type of plan, and cost sharing are verified prior to the visit so that lapsed coverage or wrong plan is identified at the time when the claim can still be revised rather than denied weeks after.
E-Submission
Services requiring prior authorization are obtained prior to submission to remove the most prevalent front-end cause for rejected claim.
Payment posting and reconciliation
Charges are entered based on the documentation and reviewed to ensure that the claim is accurate and will survive payer editing and medical necessity review.
Denial management and appeals
Each denial is coded to its source and resolved by fixing the issue at its root and appealed with the evidence required by the payers.
The Cost Of Billing In-house
The expense of bringing billing in-house seems to be less costly than it actually is because the salary line is only one line item in the expenses column. What the total cost and its inherent risk are make it worthwhile for a practice such as this to outsource.
Consider the employee first. The salary for the average medical biller stands at around $50,250. This is before payroll tax, insurance and paid vacation are considered.2 In addition to the salary is the ongoing cost of employing the individual to carry out their responsibilities: licensing software and fees, submission fees for each claim processed, as well as ongoing training in the ever-changing codes.
The bigger issue is the fragility of the process. For smaller practices, billing typically depends on one individual, making that individual a point of failure. Whenever the biller is on leave, sick, or even quits midway into the current accounts receivable cycle, the process of billing comes to a screeching halt until another person fills their shoes. The practice will also be unable to perform any sort of checks and balances since there will be only one person responsible for the posting and adjusting of payments.
The denial math is where being small really hurts. It takes $25 of administrative labor to fix one denied claim, and the industry-wide rate of denial is 8 percent while some of the best practices do better than 5 percent. Being productive means a practice will have a lot of denied claims, which then requires reworking, becoming a full-time job in and of itself, and when people do not have enough time, they write off the claims by default. As many as half to two-thirds of denied claims are never reworked by the industry.
This makes these claims lost for good when they could have been salvaged. When the claim is denied, the clock keeps ticking, and once the deadline of the insurer is reached, the claim cannot be resubmitted, and the amount is lost forever. An overdue claim does not represent late payment; after a certain time, it becomes a lost claim from which no appeal can recover.
The cost curve takes on a different shape because of outsourcing. With a percentage-of-collections billing fee structure, the payment is made contingent upon actual dollars collected, meaning that UControl is paid only if the practice receives payment. That kind of contingency is something that no salary can match, since a billing specialist’s compensation does not vary according to claim efficiency or the number of rejected claims that accumulate in the denial pile. In other words, outsourcing shifts the cost of hiring from a fixed overhead expense into a variable expense linked to revenue generation.
~$50,250
Salary of average biller (pre-benefits) BLS, May 2024
~$25
Cost of administrative handling of each denied claim MGMA
50 to 65%
Ratio of claims never resubmitted in industry MGMA
Keep Your EHR. Buy Nothing.
UControl is a billing service, not a software firm, so there is nothing to buy and nothing to migrate. They work within the existing system used by the practice, meaning there will be no need for any data migrations, no need to train the front office to use a new interface, and no forced platform lock-in to link billing to the vendor’s product line. Other billing companies offer their practice management software to route the billing through it; they require practices to change an existing software just to solve a billing issue. UControl solves billing issues using the existing tools.
Switching Is The Part We Take Care Of
The fear of moving from a failing billing practice is the shift itself; the fear that claims may fall off and money stops moving through the shift process. The shift is managed in a way that makes sure that does not occur, and the operations of the practice continue on without interruption while the shift is performed.
Agreement & access
HIPAA Business Associate Agreement is signed first, followed by payer and EHR access with minimum-necessary permissions. Nothing happens until this paperwork is completed and signed.
Parallel run
The claims are processed simultaneously along with the existing process during a limited period of time, to avoid any holes in the transition process of the biller.
Go-live
UControl takes responsibility for processing all claims once the parallel run completes successfully. Timeline is agreed upon during scoping.
Legacy A/R recovery
The existing backlog created by another biller or vendor is recovered during the transition process to ensure aged claims are processed within their limitations.
What The Practice Gains In Numbers
A billing performance indicator can be defined only through its measurement. All metrics included in reporting are provided according to the actual statistics, and there is no use of any data from industry benchmarks.
Clean claim rate
Proportion of claims passing payer edits uncorrected.
First pass acceptance
Payments received for the first claim submission.
Denial rate
Rejected claims with a reason specified.
Days in A/R
The claim remains outstanding.
Net collection rate
Total revenue collected according to allowables.
Patient collections rate
Amount of money collected from patients.
There is always someone behind the numbers. An account manager responsible for your billing performance. The person you talk to on the phone knows your practice and payers well, not forcing you to start again in a queue system every time.
Why Small Practices Choose UControl
US-based team
Coders and billers based in Brentwood, NY working your payers during your business hours, not offshore and lagging by a day.
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Certified coders
Coding is done by certified professionals, and the company is AAPC member, among others. VERIFY the particular CPC certification before using it.
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ISO-certified processes
Information Security and Quality Management follow ISO 27001 and ISO 9001, respectively, and are regularly external-audited. VERIFY current certification.
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HIPAA and BAA
Business Associate Agreement is signed, and minimum-necessary access controls apply everywhere there is protected health information.
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Reporting on demand
Monthly reporting on submissions, denials and receivables allows the practice to keep track of its finances systematically.
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Scales with the practice
Adding another provider or location gets rolled up into the same claim process without changing the platform or resetting.
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Our Credentials
We hold the certifications that payers and auditors look for, and our coders carry the right credentials. It’s not the most exciting part of the work, but it’s the part that keeps your claims on solid ground.
Explore Frequently Asked Questions
Small practice medical billing manages coding, claims, payment posting, denials, and accounts receivable so providers can focus on patient care.
Yes. UControl Billing works with existing EHR and practice management systems, including athenahealth, eClinicalWorks, Kareo/Tebra, AdvancedMD, NextGen, and ModMed.
Yes. UControl Billing provides specialty-specific medical billing and coding support for more than 60 healthcare specialties.
Yes. UControl Billing follows HIPAA-compliant billing processes and uses appropriate safeguards to protect patient information.
UControl Billing offers percentage-based pricing, with plans starting as low as 2.99% of collections. Pricing may vary based on practice needs and services.
Outsourcing can reduce administrative workload and provide professional billing, coding, denial management, and A/R support without maintaining a full in-house billing team.
We help prevent denials through eligibility verification, coding review, claim scrubbing, payer-specific checks, and ongoing denial follow-up.