Medicare billing from a team that knows MAC jurisdictional compliance, NCCI edits, and CMS adjudication rules cold. Your practice gets paid what CMS owes without the back-and-forth.
Medicare billing is the foundation of the American healthcare revenue cycle. In 2026, the financial health of a provider is dictated by the mastery of CMS billing updates, the shift toward Value-Based Care, and the rigorous management of NCD/LCD documentation requirements. A single technical error in a Medicare clean claims submission submission does not just delay payment; it risks triggering audits and significant recoupments from federal recovery contractors. We provide a specialized Medicare RCM engine designed to protect your compliance and ensure total reimbursement integrity, consistently securing a 97.4% first-pass clean claim rate.
Medicare operates under a strict Physician Fee Schedule and public-access rules. If your RCM partner treats a CMS claim with the same generic approach as a private PPO, your practice is exposed to unnecessary risk.
The federal government utilizes RAC and UPIC audits to identify overpayments. Under the 60-day overpayment rule, providers must report and return identified overpayments within 60 days of quantification — or face potential False Claims Act liability.
Our system synchronizes your clinical documentation with Medicare reimbursement protocols, ensuring every CPT code and modifier is fully defensible in the event of a federal audit.
Medicare is divided into administrative jurisdictions, each with its own Local Coverage Determinations (LCDs) backed by benefits verification services that confirm coverage before care is delivered. We verify that your documentation accurately reflects these regional requirements.
Our coders audit medical necessity signatures and time documentation data to ensure compliance with CMS guidelines for evaluation and management services, protecting you from jurisdictional claims appeal services that generic billers miss entirely.
As a dedicated RCM partner, we provide the deep federal billing knowledge that general billers simply cannot match.
CMS requirements for electronic claim submission are unforgiving. We manage mandatory reporting of all data elements, ensure time-in-record requirements are met, and automate 5010 standard checks so your practice is never penalized for technical gaps.
The Advance Beneficiary Notice is a primary tool to protect revenue when a service might not be covered. Our eligibility engine manages Part B status, remaining deductibles, secondary payer crossovers, and specific benefit limits to prevent retroactive denials within the strict 12 month filing window.
When a claim is denied for lack of medical necessity, a generalist biller often lacks the statutory knowledge to fight it. Our team utilizes specialized appeals referencing specific NCD/LCD guidelines, pursuing every level of the redetermination process for both Traditional Medicare and Medicare Advantage variances.
Private practices face enterprise-level audit risks without enterprise level resources. We provide Medicare billing services for small practices that deliver the same precision RCM utilized by large health systems — acting as your specialized federal billing department.
Providers must navigate shifting MIPS and Advanced APM requirements under the Quality Payment Program (QPP), established by MACRA.
Following the landmark 2021 and 2023 E&M leveling reforms, history and examination elements have been removed from clinical leveling. Code selection now rests entirely on Medical Decision-Making (MDM) or time-based documentation. We audit your E&M levels to ensure they reflect these modern standards, protecting your practice from upcoding flags while preventing revenue loss.
Our billing engine is optimized for the extended telehealth flexibilities preserved through December 31, 2027, under the Consolidated Appropriations Act of 2026, including the deferral of the in-person visit requirement for mental health services until January 1, 2028.
We fully support compliance with the CMS-0057-F Interoperability and Prior Authorization Final Rule, which mandates streamlined timelines for Medicare Advantage plans, requiring decisions within 7 days for standard requests and 72 hours for expedited requests.
We monitor quarterly updates to HCPCS codes and drug pricing based on Average Sales Price (ASP), ensuring your claims reflect current Medicare Part B reimbursement rates.
We work inside your EHR and manage provider enrollment through PECOS 2.0 so claims flow clean from day one. Insurance credentialing services are completed before the first claim is filed.
Navigate shifting MIPS and Advanced APM requirements to protect your payment adjustments and avoid the 9% negative adjustment through compliant quality reporting.
Tailored Medicare billing for physicians across diverse clinical specialties, with deep familiarity in the high-volume service codes that drive your revenue.
Expert tracking of Initial Preventive Physical Exams (IPPE), Annual Wellness Visits (AWV), and Diabetes Self-Management Training (DSMT).
Specialized workflows for the CMS enrollment expansion — LPCs, MFTs, MHCs, and LCSWs, alongside Behavioral Health Integration (BHI).
Precise administration of Transitional Care Management (TCM) and Chronic Care Management (CCM) under value-based care tracks.
Accurate modifier assignment is critical for physician services billed under the Medicare hospice benefit. Our team ensures correct GV and GW modifier usage to prevent claim denials and protect reimbursement for attending and non-attending physicians.
Note on Scope: Our services are strictly focused on professional fee billing and clinical practice revenue cycles. We do not provide Durable Medical Equipment (DME) or ambulatory surgical center (ASC) facility billing.
Our Medicare RCM services integrate directly into your existing infrastructure. We support seamless API and clearinghouse connections with over 10 major EHR/PM platforms.
When handling federal payer data, security is non-negotiable. Revix MD protects your practice with comprehensive data defense protocols:
Real outcomes from practices that transitioned their Medicare billing operations to Revix MD.
A large multi-provider clinic was losing 14% of expected payments due to outdated local coverage knowledge and coding errors. Within 90 days, clean claim rate jumped to 99%.
Clean Claim Rate
Recovered in 90 Days
A regional practice struggled with 50+ day DSO due to poor secondary payer coordination. Automated crossover synchronization reduced Medicare DSO to 24 days.
Days DSO Achieved
DSO Reduction
Following the CMS enrollment expansion for mental health counselors, a BH group onboarded 12 LPCs and LMFTs via PECOS 2.0, generating $115K in new compliant Medicare revenue within six months.
New Revenue (6 Months)
Providers Enrolled
Request a free Medicare revenue audit. We’ll identify compliance gaps, denial patterns, and underpayment exposure — then present a clear recovery plan.
We use distinct workflows for each. We ensure strict compliance with different regulations, including the CMS-0057-F mandate for 7-day standard and 72-hour expedited prior authorizations.
Yes. We manage the entire CMS expansion process for LPCs, LMFTs, and MHCs from initial provider credentialing to accurate coding and daily psychotherapy session billing.
Our compliance software monitors accounts in real time to identify credit balances early. We help you report and return funds within 60 days, avoiding False Claims Act penalties.
Yes. Our platform tracks exact time-based data for CCM codes and automatically alerts your staff when patients become eligible for Annual Wellness Visits or initial Medicare exams.
Generalists often miss Medicare-specific modifiers and modern E&M leveling rules. Our specialized focus ensures precise regulatory compliance, timely filing, and significantly fewer redetermination appeals.
We use distinct strategies: navigating Traditional Medicare via the five-level redetermination process using NCD/LCD statutes, and holding Medicare Advantage plans accountable to internal processes and 2026 CMS guidelines.
