Medical Billing & RCM - Your Questions, Answered

A medical billing company manages the financial side of your patient care on your behalf. This includes verifying patient insurance, assigning the correct billing codes, submitting claims to payers, following up on unpaid claims, appealing denials, and posting payments. B3CARE handles all of these functions as a complete, outsourced billing department - or we can take on specific pieces of your billing workflow.

Yes - in most cases, outsourcing saves small practices more money than it costs. When you factor in salary, benefits, training, software, and the cost of billing errors for an in-house team, the percentage-based fee for a professional billing company is typically lower. More importantly, a specialized billing company often achieves a higher clean claim rate and lower denial rate than an overwhelmed in-house staff member trying to keep up with payer rule changes.

B3CARE uses a percentage-of-collections pricing model, meaning we only earn when you get paid. Our fees are a percentage of actual collections - not billed charges or submitted claims. This aligns our incentives with yours. We also offer flat-fee arrangements for specific services like credentialing and new practice setup. Contact us for a custom quote based on your specialty and claim volume.

A clean claim is one that passes all payer edits and is accepted for adjudication on first submission. A high clean claim rate above 95% means fewer denials, faster payment, and lower administrative costs. B3CARE's average first-pass claim acceptance rate is 96%+, compared to an industry average that often falls between 75-85% for in-house billing.

Most commercial payers process electronic claims within 14-30 days. Medicare typically adjudicates within 14 days for electronic claims. If you're consistently waiting longer, your denial rate may be higher than you realize, or claims may be sitting in a payer's error queue. B3CARE monitors all submitted claims daily and follows up on any claim exceeding standard payer timelines.

A rejection happens before adjudication - the claim never makes it into the payer's system because it has a technical error such as a wrong NPI, invalid date format, or missing data. A denial happens after adjudication - the payer received the claim, processed it, and decided not to pay. Rejections are fixed and resubmitted quickly. Denials require an appeal process. B3CARE addresses both through front-end claim scrubbing and a dedicated denial management workflow.

Commercial payer credentialing typically takes 60-120 days. Medicare and Medicaid enrollment can take 30-90 days depending on the payer and any missing documentation. These timelines are why it's critical to start credentialing before your practice opens - not after. B3CARE's credentialing team tracks every application milestone and works proactively with payers to avoid delays.

Yes, in some situations. Provisional credentialing arrangements and retroactive billing rules allow you to bill for certain services under a credentialed supervising physician while your application is processed. The rules vary by payer. B3CARE navigates these nuances routinely and can help you capture revenue that would otherwise be lost during the credentialing period.

Medicare Part A covers hospital inpatient services, skilled nursing facility care, and hospice. Part B covers physician services, outpatient care, and durable medical equipment. Part C, also called Medicare Advantage, is private insurance that replaces traditional Medicare, with its own billing rules and prior authorization requirements. Part D covers prescription drugs. B3CARE provides billing support across all four Medicare parts, including complex Medicare Advantage contracting.

A Local Coverage Determination, or LCD, is a Medicare Administrative Contractor's decision about whether a service or procedure is covered for specific diagnoses in their jurisdiction. LCDs directly affect what diagnosis codes you must use to support medical necessity. B3CARE's billers stay current on LCD changes for each MAC jurisdiction to ensure your claims are filed with compliant documentation.