Medical Billing FAQ

How does outsourcing medical billing work?

You keep seeing patients and documenting encounters the way you always have. We connect to your EHR or practice management system, pull the encounter data, code it, scrub it, submit claims, post payments, work denials, manage A/R, and handle patient billing. You get monthly reports showing exactly where your money stands. Learn more about our billing and coding services.

How long does it take to get started?

Most practices are fully transitioned within two to three weeks. We handle the EHR connection, learn your workflows, and start processing claims. There’s no downtime in your billing during the transition.

Do I need to change my EHR or practice management system?

No. We integrate with every major platform: eClinicalWorks, Athenahealth, AdvancedMD, Kareo/Tebra, DrChrono, NextGen, Epic, Cerner, and dozens more. If your system exports claims or connects via API, we work with it. We also offer free EMR software for practices that need an upgrade.

Will I have a dedicated point of contact?

Yes. Every client gets a named account manager who knows your practice, your payers, and your billing patterns. When you call, a real person answers. You won’t get routed through a call center.

What if I’m not happy with the service?

We don’t lock clients into long term contracts. Our retention rate is high because our results speak for themselves, not because of contractual obligations. You can cancel anytime.

How much does Go Medical Billing charge?

Starting at 2.49% of net collections. That’s well below the industry average of 4 to 10%. We only get paid when you get paid. No setup fees, no monthly minimums, no hidden charges. See our pricing page for details.

How does your pricing compare to in house billing?

In house billing typically costs 8 to 12% of collections when you add up salaries, benefits, software licenses, clearinghouse fees, training, and management oversight. A single full time biller costs $35,000 to $65,000 depending on your market. At 2.49%, our entire team costs a fraction of one employee.

Are there any hidden fees?

No. Our 2.49% rate covers billing, coding, claim submission, denial management, A/R follow up, payment posting, and monthly reporting. Credentialing, eligibility verification, and prior authorization support are included at no additional charge.

What does ‘pay for paid’ mean?

We only charge a percentage of what we actually collect for your practice. If a claim doesn’t get paid, you don’t pay us anything on that claim. Our incentives are directly aligned with yours.

Are your coders certified?

Yes. Our coding team holds active AAPC and AHIMA certifications. They complete continuing education annually and stay current on ICD-10, CPT, and HCPCS coding updates. Learn more about our coding services.

What is your clean claim rate?

Our clean claim rate is above 98%. Every claim is scrubbed against payer specific edits before submission. We catch coding errors, demographic mismatches, authorization gaps, and bundling conflicts before the payer sees the claim.

How do you handle claim denials?

We categorize every denial by root cause (eligibility, coding, authorization, medical necessity, timely filing) and apply the correct resolution path. Every appeal includes specific documentation and coding rationale. We also track denial patterns to fix upstream issues that cause recurring denials. This is part of our A/R recovery services.

What reports will I receive?

Monthly reports covering collections by payer, denial rates by reason code, A/R aging by bucket, clean claim rate, and key revenue cycle metrics. You’ll know exactly where your money stands at all times.

Do you handle credentialing?

Yes. We manage the entire credentialing lifecycle: CAQH ProView setup, PECOS Medicare enrollment, commercial payer applications, Medicaid managed care enrollment, contract negotiation, and re-credentialing management. Learn more about our credentialing services.

How long does credentialing take?

Commercial payers generally take 60 to 120 days. Medicare takes 60 to 90 days depending on the MAC region. We begin immediately and follow up aggressively to minimize delays. Every day without active enrollment is permanently lost revenue.

Can you help with re-credentialing?

Yes. We maintain a calendar of every provider and payer combination and initiate re-credentialing 90 days before expiration. Missing a re-credentialing deadline can result in network termination.

Do you negotiate payer contracts?

Yes. Before you sign any participation agreement, we review the proposed fee schedule against Medicare benchmarks and regional commercial averages. If rates are below market for your high volume CPT codes, we negotiate for better terms.

Which specialties do you work with?

We serve 40+ specialties including cardiology, urology, urgent care, behavioral health, orthopedics, ABA therapy, DME, laboratory, internal medicine, dermatology, pain management, OB/GYN, gastroenterology, and more. Each specialty has dedicated coders who understand its specific coding requirements. See our specialties page.

Do you serve practices in all 50 states?

Yes. We work with physicians in every state and know the specific payers, Medicaid programs, and billing rules for each market. See our states we serve directory for state specific details.

Can you handle both professional and facility billing?

Yes. We submit professional claims on CMS-1500 and institutional claims on UB-04. We handle both billing types for practices that operate across office and facility settings.

Do you work with solo practitioners?

Absolutely. Many of our clients are solo providers or small groups. Our pricing model (percentage of collections) scales naturally, so you get the same full service team whether you see 30 patients a week or 300.

Are you HIPAA compliant?

Yes. We maintain full HIPAA compliance with encrypted data transmission, role based access controls, documented security policies, regular staff training, and business associate agreements with every vendor we work with.

How do you protect patient data?

End to end encryption for all data in transit and at rest. Role based access controls so staff only see the data they need. Documented security policies and incident response plans. Regular security training for all team members.

Will you help us stay compliant with coding and billing regulations?

Yes. Our team tracks every CMS update, payer policy change, ICD-10 revision, and state specific regulation that affects your billing. When rules change, we update your workflows before the effective date. Learn more about our chart auditing services.

Do you handle prior authorizations?

Yes. We manage the entire authorization lifecycle: eligibility verification, clinical documentation preparation, payer submission, status tracking, and retro authorization recovery for services performed without prior approval. Learn more about our prior auth services.

What about the new CMS prior auth rules for 2026?

The CMS Interoperability and Prior Authorization Final Rule now requires payers to respond within 72 hours for expedited requests and 7 calendar days for standard requests. We track these deadlines and escalate when payers miss them.