Primary Care Medical Billing Services

Primary care medical billing follows strict CMS preventive service guidelines, Medicare and Medicare Advantage regulations, Medicaid policies, and commercial payer billing standards. Primary Care Physicians providing services such as annual wellness visits, preventive exams, chronic care management, immunizations, transitional care management, and same-day sick visits must work within payer rules that directly affect coding accuracy, documentation, modifier use, and reimbursement timelines.

MZ Medical Billing handles the complete primary care revenue cycle, including patient eligibility verification, charge entry, coding review, electronic claim submission, ERA/EOB reconciliation, payment posting, denial correction, and accounts receivable follow-up.

Each step is performed according to Medicare, Medicaid, and commercial payer requirements, with processes designed for practices with a high volume of visits.

Billing for Primary Care Physicians involves daily coordination with Medicare Administrative Contractors (MACs), Medicare Advantage plans, state Medicaid programs, and commercial insurers. Claims are checked for preventive benefit eligibility, chronic care documentation, modifier -25 rules, referral requirements, prior authorization criteria, and enrollment verification to reduce claim rejections.

Our internal audits highlight documentation gaps, CPT and ICD-10 mismatches, modifier errors, medical necessity concerns, preventive and problem-visit bundling issues, and underpaid claims. Denials are corrected and resubmitted according to payer timelines, and aging accounts are reviewed regularly to maintain steady cash flow.

Primary care practices and Primary Care Physicians working with MZ Medical Billing generally see 96–98% claim approval rates, 95–97% first-pass resolution rates, and accounts receivable averages between 26 –30 days across Medicare, Medicaid, and commercial insurance plans. These results come from accurate coding, complete documentation, correct modifier application, and attention to the specific rules that govern billing for primary care services.

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98%
Claim Approval Rate

97%
First pass Ratio

<30
Days in AR

96%
Collection Ratio

Outsourcing Primary Care Billing with MZ Billing

Outsourcing primary care billing to MZ Medical Billing provides practices with a certified, HIPAA-compliant billing team that manages the full revenue cycle accurately and in compliance with regulations. Our team of certified professional coders (CPC) and certified professional billers (CPB) handles patient eligibility verification, charge entry, CPT/ICD-10 coding validation, modifier application, electronic claim submission, payment posting, denial management, and accounts receivable follow-up for practices of all sizes, including solo physicians, multi-provider group practices, hospital-affiliated outpatient clinics, urgent care within primary care, and specialty-integrated primary care practices.

Primary care billing covers a broad range of services, each with specific coding, documentation, and payer requirements, including annual wellness visits, preventive exams, chronic care management, transitional care management, immunizations, same-day sick visits, minor procedures, and behavioral health screenings. Each claim is reviewed for Medicare, Medicaid, and commercial insurance compliance, including preventive benefit eligibility, chronic care documentation, modifier -25 application, referral rules, prior authorization, and correct patient enrollment.

Our billing process follows HIPAA, OIG, and CMS guidelines, providing compliance at every step. Internal audits detect documentation gaps, CPT/ICD-10 mismatches, missing or incorrect modifiers, medical necessity issues, bundling conflicts, and underpaid claims. Denials are corrected and resubmitted on schedule, while aging accounts are monitored to maintain consistent revenue flow.

We integrate with leading EHR and practice management systems to automate eligibility checks, claim scrubbing, and reporting. Practices receive real-time dashboards and detailed reports to track claim status, denial trends, payer performance, and revenue recovery opportunities.

MZ Medical Billing supports Primary Care Physicians across all specialties, including:

Family Practice Physicians – care for all ages, routine check-ups, chronic disease management, and preventive screenings
Internal Medicine Physicians – adult chronic and complex care, diagnostics, and preventive visits
Pediatricians (Primary Care Physicians for Children) – well-child visits, immunizations, developmental assessments, and acute care
Geriatric Primary Care Physicians – multi-morbidity management, complex Medicare documentation, preventive screenings, and care coordination
OB-GYN Primary Care Physicians – women’s health screenings, prenatal counseling, early pregnancy care, and preventive exams
Urgent Care Primary Care Physicians – same-day visits, minor procedures, wound care, and layered appointments
Sports Medicine Primary Care Physicians – injury assessment, musculoskeletal management, and physical therapy coordination
Preventive and Wellness Primary Care Physicians – annual physicals, health screenings, lifestyle counseling, and risk assessments
Chronic Disease Management Primary Care Physicians – management of diabetes, hypertension, asthma, cardiovascular conditions, and other chronic illnesses
Behavioral Health–Integrated Primary Care Physicians – mental health screenings combined with physical health management
Occupational Health Primary Care Physicians – pre-employment screenings, work-related health evaluations, and immunizations
Telehealth Primary Care Physicians – remote consultations, chronic condition follow-ups, preventive care, and patient education

Practices working with MZ Medical Billing typically experience 22–30% fewer claim denials, 10–18% faster reimbursement timelines, and up to 25% higher overall collections. These results reflect structured workflows, certified coding expertise, technology-driven claim management, and strict adherence to payer requirements.

Outsourcing primary care billing allows practices to focus on patient care while maintaining accurate, compliant, and efficient revenue cycle management.

Why Primary Care Billing Is Complex

Primary care billing may look routine from the outside, but it is one of the most coding-intensive and regulation-sensitive areas of healthcare. A single day in a primary care practice can involve:

An Annual Wellness Visit (G0438) with multiple preventive screenings
Follow-ups for chronic conditions such as hypertension or diabetes (99214)
Immunizations for children or adults (90460–90474)
A same-day sick visit layered onto a scheduled check-up
Telehealth consultations, college physicals, mental health screenings, or medication refills

Each service has unique coding, documentation, modifier, and payer requirements. Errors affect revenue and compliance:

Applying the wrong G-code or E/M level can lead to denials
Missing modifier 25, 59, or 33 may trigger claim bundling or rejected telehealth visits
Skipping time tracking on chronic care codes (99490, 99487) can result in no payment
Incorrect diagnosis linkage for vaccines or preventive services may cause denials

Billing is complex because these decisions occur frequently, for many services, across multiple payers, and are subject to CMS, MAC, OIG, and commercial auditing rules.

Primary care practices handle high patient volumes and multiple payers, each with slightly different rules. E/M codes, the most commonly used, are also the most audited, and must match chart documentation, visit complexity, and medical decision-making.

Internal medicine physicians often manage chronic and multi-morbidity patients, requiring special coding for chronic care management, principal care management, and transitional care. These services have strict time, documentation, and coding requirements; missed billing is a common source of lost revenue.

Preventive vs. problem-focused visits are another challenge. For example, a patient may come in for an annual physical but also report a health concern. Claims must be split properly to capture both services; errors can reduce reimbursement or trigger denials.

Primary care billing is complex not because the services are rare, but because they happen continuously, involve multiple codes, require strict documentation, and must comply with regulatory and payer-specific rules. Accurate billing requires constant attention to coding, modifiers, payer rules, and documentation.

Leading Primary Care Billing Services

MZ Medical Billing stands out among medical billing providers by improving the revenue cycle for primary care practices through accurate coding, compliance, and data-driven reporting. We serve as a full-service billing partner, managing every phase of the billing process to reduce claim denials, accelerate reimbursements, and support predictable financial performance for family practice, internal medicine, pediatrics, geriatrics, OB-GYN, urgent care within primary care, and integrated specialty practices.

Structured Revenue Cycle Management

MZ Medical Billing improves the revenue cycle for primary care practices through accurate coding, compliance, and clear reporting. We manage every stage of the billing process to reduce claim denials, accelerate reimbursements, and maintain stable financial performance for family practice, internal medicine, pediatrics, geriatrics, OB-GYN, urgent care within primary care, and integrated specialty practices.

End-to-End Primary Care Billing Services

Our services cover the full revenue cycle:

Patient registration and insurance eligibility verification
CPT/ICD-10 coding review and validation
Charge entry and claim submission
Payment posting and reconciliation
Denial management and resubmissions
Accounts receivable follow-up and recovery

Claims meet Medicare, Medicaid, and commercial payer requirements, including preventive visits, chronic care management, transitional care, same-day sick visits, and layered appointments. This reduces denials, prevents underpayment, and maintains steady revenue.

Compliance and Policy Updates

Our billing specialists track updates from federal and state payers, Medicare Administrative Contractors (MACs), and commercial insurers. Changes are applied promptly when:

Fee schedules or CPT/ICD-10 updates are released
Payer policies or prior-authorization rules change
Preventive or chronic care billing rules are revised

This approach prevents denials caused by outdated procedures and keeps primary care billing aligned with current regulations.

Audit-Ready Billing Practices

Primary care billing faces frequent audits due to high-volume E/M services, preventive claims, chronic care management, and layered visits. Our team manages audit risk by:

Conducting internal audits to identify documentation gaps, coding errors, and missing modifiers
Applying correct E/M codes, chronic care management codes (99490, 99487, 99491), and preventive service codes
Following payer-specific requirements for modifiers, encounter reporting, and billing splits

This reduces the risk of recoupments, delayed payments, and compliance penalties.

Practice-Specific Workflows

Every primary care practice has a unique payer mix, patient population, and operational structure. We custom-fit billing procedures to match each practice while maintaining accuracy, compliance, and reporting standards across Medicare, Medicaid, and commercial payers.

Accuracy and Verification

Each claim is reviewed for correct coding, documentation, and modifier application before submission. Errors are identified early, reducing denials and supporting predictable reimbursement timelines.

With extensive experience in primary care billing, payer compliance, and specialty-specific coding, MZ Medical Billing helps practices maintain revenue, reduce compliance risk, and support long-term financial performance.

Primary Care Medical Billing Services We Offer

MZ Medical Billing Services provides complete medical billing and revenue cycle management for Primary Care Physicians, including family medicine, internal medicine, pediatrics, geriatrics, and outpatient primary care clinics. Primary care reimbursement is driven primarily by evaluation and management (E/M) services, preventive visits, chronic condition management, and high patient-volume office encounters. Billing processes follow current CMS documentation standards, Medicare Administrative Contractor policies, Medicaid regulations, commercial payer contracts, and National Correct Coding Initiative (NCCI) edits.

Our certified billing and coding professionals, credentialed through AAPC and AHIMA, work with independent practices, rural health clinics (RHCs), FQHCs, and multi-provider primary care groups. Workflows are built around payer policy manuals, CPT and HCPCS coding standards, and federal compliance requirements.

Revenue Cycle Management (RCM) for Primary Care

We manage the complete billing cycle for primary care practices, including preventive visits, chronic and transitional care management, same-day sick visits, immunizations, and layered appointments. Each claim is reviewed for ICD-10-CM, CPT, and HCPCS compliance, with payer-specific rules for Medicare, Medicaid, and commercial plans. E/M codes are matched to chart documentation, and modifiers like -25 are applied when visits include both preventive and problem-focused services. Claims are checked for documentation support, NPI accuracy, and payer requirements before clearinghouse submission. Payment posting includes ERA/EOB reconciliation, contractual adjustments, and identification of underpayments or duplicates, while reporting monitors reimbursement trends and accounts receivable aging.

Medical Coding Services for Primary Care

Certified CPC and CCS coders assign diagnosis and procedure codes for all primary care services, including annual wellness visits, chronic condition management, immunizations, same-day sick visits, and preventive screenings. Documentation is checked for medical necessity, correct code selection, modifier application, and compliance with National Correct Coding Initiative (NCCI) edits. E/M codes are audited for level selection based on medical decision-making and time documentation, while immunizations and preventive services are linked to the correct ICD-10 and G-codes. This review reduces denials, supports audit readiness, and maintains accurate reimbursement across Medicare, Medicaid, and commercial payers.

Denial Management

Claims are categorized by cause, including missing modifiers, incomplete documentation, eligibility discrepancies, prior authorization lapses, or bundling errors. Root causes are addressed at the workflow level to improve first-pass claim acceptance. Reporting monitors patterns across preventive visits, chronic care services, and immunizations to reduce repeated denials and support stable revenue.

Patient Billing Services

Patient statements are generated with itemized charges reflecting payer adjudication and cost-sharing obligations. Inquiries are managed according to plan benefits, EOB details, and regulatory requirements. Account balances are reconciled with insurance payments and contractual adjustments to maintain accuracy. Clear, detailed statements support primary care practices in collecting patient responsibility without administrative delays.

Appeals and Disputes Management

Denied or underpaid primary care claims are reviewed for compliance with payer-specific policies and federal regulations. Appeals include medical records, coding references, supporting documentation for medical necessity, and proof of timely filing. Denial trends are analyzed to identify recurring documentation, coding, or workflow issues, allowing practices to correct systemic errors that affect revenue.

Insurance Verification Services

Eligibility and benefits are verified before each primary care visit. Copays, deductibles, coverage limits, referral rules, and prior authorization requirements are documented in patient accounts. This step minimizes claim delays, prevents coverage disputes, and confirms eligibility for preventive and chronic care services, including Medicare Annual Wellness Visits and Medicaid-covered immunizations.

Referral and Authorization Management

Prior authorizations are obtained and tracked for diagnostic testing, therapy services, specialty referrals, and other primary care–related procedures. Authorization details are attached to claims when required. This workflow prevents claim denials or delays caused by missing approvals and ensures compliance with payer-specific requirements.

Payment Posting

Insurance and patient payments are posted daily with ERA/EOB reconciliation. Underpayments, overpayments, and duplicate entries are identified and flagged for correction. All contractual adjustments are applied, keeping primary care ledgers accurate and up to date for both insurance and patient payments.

Old A/R Cleanup

Accounts aged beyond normal processing timelines are reviewed and corrected for filing within payer limits. Non-collectible or inactive accounts are resolved to recover lost revenue and maintain accurate accounts receivable records. This process applies to preventive, problem-focused, and chronic care visits alike.

Medical Billing Write-Off Recovery

Historical write-offs are audited against payer contracts and reimbursement rules. Claims with recoverable errors are corrected and resubmitted, restoring revenue that may otherwise remain uncollected. This includes adjustments for preventive care, immunizations, chronic care management, and problem-focused visits.

Accounts Receivable (A/R) Recovery

Outstanding accounts are tracked by payer, service type, and aging category. Follow-up is conducted with carriers to resolve pending claims, correct documentation, and recover delayed payments. This ensures primary care practices maintain steady cash flow and reduces aged A/R balances.

Claims Submission

All primary care claims are verified for coding accuracy, documentation completeness, modifier usage, and payer-specific rules before submission through clearinghouses. This review includes preventive services, chronic care management, immunizations, and same-day sick visits, reducing rejected or denied claims and improving first-pass acceptance rates.

Common Primary Care Billing Codes We Work With

Primary care practices handle a wide range of services each day, from routine office visits and preventive exams to same-day sick visits, immunizations, and telehealth consultations. Accurate coding is essential to capture all billable services, avoid claim denials, and comply with Medicare, Medicaid, and commercial payer rules. The following codes are commonly used in primary care billing and reflect the spectrum of care provided.

Office Visit and E/M Codes

99202, 99203, 99204, 99205 — New patient office visits, Levels 2–5
99212, 99213, 99214, 99215 — Established patient office visits, Levels 2–5

Selection is based on visit complexity, time, and documentation of medical decision making. Modifier 25 is applied when a problem-focused service occurs on the same day as a preventive or routine visit.

Preventive Care Codes

99381–99387 — Preventive visits for new patients, all age groups
99391–99397 — Preventive visits for established patients, all age groups
G0438, G0439 — Medicare Annual Wellness Visit, initial and subsequent

Preventive codes require age-appropriate screenings and completion of the Medicare Personalized Prevention Plan of Service (PPPS) when applicable.

Immunization and Vaccine Administration Codes

90460, 90461 — Vaccine administration with counseling, patients 18 and under
90471, 90472 — Vaccine administration, patients 19 and older

Documentation includes vaccine type, dosage, route, and patient consent. Certain adult vaccines, such as shingles or pneumococcal vaccines, have additional CPT codes (e.g., 90734, 90732).

Modifier Codes Commonly Used in Primary Care

Modifier 25 — Significant, separately identifiable E/M service on the same day as a procedure
Modifier 33 — Preventive service with no cost-sharing
Modifier 59 — Distinct procedural service to prevent bundling errors
Modifier 95 — Telehealth services delivered via real-time audio/video

Correct modifier use separates multiple services on the same day, addresses telehealth visits, and supports accurate claim processing.

Common Problems Primary Care Practices Face in Medical Billing

Complex Payer Requirements

Primary care practices work with multiple payers, including Medicaid, Medicare, and commercial insurance plans. Each payer has different authorization rules, documentation expectations, encounter-data requirements, and billing formats. Missing a required referral, using outdated eligibility information, or applying the wrong payer-specific rules can lead to claim denials or delayed payments.

Frequent Policy and Coding Updates

Medicare, Medicaid, and commercial payers regularly update billing manuals, fee schedules, CPT/HCPCS coverage rules, telehealth billing requirements, and preventive care coding guidelines. Submitting claims with outdated codes or modifiers can result in reduced payments, denied preventive or chronic care services, or incorrect reimbursement for layered visits.

Authorization and Documentation Gaps

Authorization errors are a leading cause of denials in primary care, particularly for chronic care management, same-day sick visits, immunizations, and specialty referrals. Common issues include missing or expired authorizations, incorrect CPT/ICD-10 pairing, unsigned progress notes, incomplete encounter documentation, and missing preventive care forms. These gaps can reduce reimbursement or trigger claim denials.

Dual Eligibility and Coordination of Benefits (COB)

Many primary care patients are covered by both Medicare and Medicaid. Incorrect primary/secondary sequencing or outdated COB information can cause claims to be suspended, denied as duplicates, or delayed for months. Small practices often lack the resources to resolve these issues quickly.

Delayed Reimbursements and High A/R Aging

Primary care practices face long payment cycles when claims are denied or returned for corrections. Preventive care, chronic care management, and immunizations may require multiple claim adjustments across payers. Without structured follow-up, accounts receivable can age 45–90+ days, especially for high-volume practices.

Audit Exposure and Encounter Accuracy

Payers routinely review primary care claims for documentation completeness, coding precision, medical necessity, and authorization compliance. Missing notes, unsigned documentation, or incorrect coding for preventive, chronic, or telehealth visits can trigger recoupments, repayment demands, or post-payment audits.

Provider Enrollment and Revalidation Challenges

For practices submitting Medicaid or Medicare claims, missing or outdated enrollment, expired revalidation, or incorrect provider or location data can block claim submission and delay payment. Linking NPIs and updating practice details is critical to maintain uninterrupted billing.

Technical Rejections from Clearinghouses and Payer Systems

Claims that fail taxonomy checks, NPI validation, attachment requirements, or payer-specific formatting never reach the insurance adjudication stage. In primary care, this can delay reimbursements for routine office visits, preventive exams, or immunizations.

How MZ Medical Billing Addresses Primary Care Challenges

Daily Management of All Payers

Our team handles claims for Medicaid, Medicare, and all commercial carriers used by primary care practices. Each claim is processed according to payer rules for submissions, encounters, and corrections, reducing preventable denials.

Immediate Updates for Policy and Coding Changes

We track updates to fee schedules, CPT/HCPCS codes, telehealth requirements, preventive care rules, and payer bulletins. These updates are applied immediately, preventing claims from being submitted with outdated codes or modifiers.

Authorization Verification and Documentation Checks

Before submission, authorizations are verified and documentation is reviewed for correct CPT/ICD-10 combinations, preventive and chronic care coding, therapy visit counts, signed encounter notes, and telehealth modifier compliance. Claims are submitted only after all required documentation is complete.

Correct Dual-Eligible Claim Sequencing

Eligibility and COB data are verified across Medicare and Medicaid systems to prevent suspended claims, duplicate denials, or secondary payer delays.

Organized Denial Management and A/R Recovery

Claims are tracked on 30-, 60-, and 90-day cycles. Denials are corrected, claims resubmitted, and disputes escalated when necessary. Underpayments are audited against fee schedules to recover lost revenue, reducing A/R aging and improving cash flow.

Audit-Ready Submissions

Claims and encounters are submitted with complete documentation, including E/M notes, preventive service forms, immunization records, and chronic care management logs. This reduces audit findings and repayment requests.

Provider Enrollment and System Management

We manage enrollment, revalidation, NPI linking, and practice updates to prevent claim suspensions and payment delays.

Technical Validation for Clearinghouse and Payer Systems

Before submission, claims are checked for taxonomy, NPI linkage, required attachments, formatting, and encounter-data accuracy. This minimizes rejections and increases first-pass claim approval.

Meet Our Expert Primary Care Billing Team

Our primary care billing team consists of certified billing and coding professionals with direct experience managing Medicare, Medicaid, and commercial payer requirements for primary care practices. Each specialist focuses on reducing claim denials, improving coding accuracy, and maintaining consistent revenue flow, helping practices navigate complex payer rules while managing routine office visits, preventive care, chronic care, and telehealth services.

Expert Skill	What We Do
Certified Professionals	Our coders and billers hold AAPC and AHIMA credentials and have hands-on experience with primary care billing, including preventive visits, chronic care management, transitional care, immunizations, and telehealth. They follow payer-specific requirements for claims, authorizations, and documentation, in line with Medicare, Medicaid, and commercial plan rules.
Payment & Reimbursement Analysis	We review ERAs, EOBs, and payer contracts to identify underpayments, incorrect adjustments, missed rate updates, and delayed reimbursements. These reviews help primary care practices recover lost revenue and maintain predictable cash flow for office visits, preventive services, and chronic care management.
Data-Driven Auditing	Our team audits primary care claims to identify documentation gaps, incorrect code usage, and missed billable services. Denials are tracked by type and payer, allowing for corrections and focused appeals that recover revenue efficiently.
Denial Management & Appeals	Denied or underpaid claims for office visits, preventive care, chronic care, immunizations, and telehealth visits are reviewed and corrected. Appeals include supporting medical records, coding references, and proof of timely filing to resolve outstanding balances.
Compliance and Policy Monitoring	Payer rules and coding guidelines for primary care are updated regularly. Our team monitors all Medicare, Medicaid, and commercial payer bulletins and applies code changes, modifier updates, and policy adjustments immediately to active claims. This reduces rejections and maintains accurate reimbursement for preventive, chronic, and routine primary care services.

Why Primary Care Practices Should Consider Outsourcing Medical Billing

Primary care practices manage a high volume of patient visits, preventive care, chronic care management, immunizations, and telehealth services. Outsourcing medical billing allows these practices to maintain accurate financial records, comply with payer requirements, and reduce administrative burden while keeping control over revenue and documentation quality.

Operational Relief and Accuracy

Billing for primary care involves numerous codes, modifiers, and payer-specific rules. Outsourcing ensures claims for office visits, preventive screenings, chronic care management, and telehealth are reviewed for coding accuracy, proper documentation, and eligibility verification before submission. This reduces denials and minimizes lost revenue from errors in CPT, ICD-10, or E/M coding.

Reliable Cash Flow

An outsourced billing team manages the full revenue cycle, from charge entry and claim submission to follow-ups and payment posting. Delayed payments, underpayments, and payer rejections are addressed promptly, keeping accounts receivable within reasonable aging periods and providing predictable cash flow without adding internal administrative work.

Payer Compliance Expertise

Medicare, Medicaid, and commercial payers have distinct rules for primary care services. Outsourced billing teams track updates to CPT/HCPCS codes, modifier usage, preventive care coverage, chronic care billing requirements, and telehealth regulations. This expertise reduces compliance risk and ensures that claims meet current payer standards.

Denial Management and Revenue Recovery

Primary care claims can be denied due to missing modifiers, incomplete documentation, or incorrect coding for preventive or chronic care visits. Outsourced teams analyze denial trends, correct claim errors, and appeal underpaid or rejected claims. Historical write-offs and delayed payments are reviewed to recover revenue that may otherwise remain uncollected.

Scalable Support

As primary care practices grow—adding new providers, telehealth services, or additional locations—outsourced billing adapts without disrupting existing workflows. Practices can handle increased claim volume while keeping internal staff focused on patient care.

Financial Reporting and Insights

Outsourced billing includes reporting on claim submission rates, denials, payment turnaround, and accounts receivable aging. This gives primary care practices clear visibility into revenue performance and highlights operational issues before they impact cash flow.

More Time for Patient Care

With claims management, follow-ups, and payer compliance handled externally, providers and staff can concentrate on clinical responsibilities. Outsourcing reduces the administrative burden while maintaining oversight of the practice’s financial health.

Primary Care Medical Billing and RCM Services for Physicians Nationwide

MZ Medical Billing Services provides full Medical Billing and Revenue Cycle Management (RCM) for primary care physicians and their practices across all 50 U.S. states, including Arizona, California, Texas, Florida, New York, Illinois, Ohio, Georgia, and Washington.

Our team manages state-specific payer systems, applying correct CPT/HCPCS codes, E/M documentation standards, modifiers, and authorization rules to maintain accurate reimbursements and reduce claim denials. We handle billing for routine office visits, preventive care, chronic care management, immunizations, and telehealth services, capturing the full spectrum of care primary care physicians provide.

Claims are submitted in compliance with Medicare, Medicaid, and commercial payer rules, following CMS guidelines, NCCI edits, and payer-specific documentation requirements. Authorizations, coding, and supporting documentation are verified prior to submission, reducing denials, improving first-pass claim acceptance, and accelerating payment cycles. Our team tracks state-specific policy changes, payer updates, and billing requirements to maintain workflow accuracy and compliance.

By partnering with MZ Medical Billing Services, primary care physicians gain a team that combines nationwide RCM experience with specialized knowledge of primary care operations. Claims are accurate, fully documented, and audit-ready, allowing physicians to focus on patient care while maintaining reliable, consistent financial performance.

United States - States Map - Our Medical Billing Locations

Comprehensive Primary Care Billing with Full Specialty Coverage

MZ Medical Billing Services provides complete revenue cycle management for primary care practices while also supporting a wide range of medical and surgical specialties. Our team works with independent physicians, group practices, outpatient clinics, and facility-based providers.

For primary care, we cover every major discipline, including:

Family Medicine – Preventive visits, chronic disease management, immunizations, transitional care management, and annual wellness visits.
Internal Medicine – Complex multi-condition billing, Medicare-focused services, risk-adjusted coding, and chronic care documentation review.
Pediatrics – Well-child visits, vaccine administration, developmental screening, and Medicaid and commercial payer billing.
Geriatrics – Senior care services, care coordination, chronic care management, and Medicare annual wellness visits.
OB/GYN (Gynecology and Women’s Health) – Preventive exams, maternity-related services, minor procedures, and diagnostic services billed under primary or specialty care structures.
Community and Multi-Provider Primary Care Clinics – High-volume E/M services, care coordination programs, and multi-payer claims processing.

In addition to primary care, we provide billing services for a full spectrum of specialties, including:

Behavioral Health Services – Psychiatry, counseling, outpatient therapy, and intensive behavioral programs, with session-level tracking and documentation verification under Medicare, Medicaid, and commercial payer rules.
Substance Use Treatment Centers – Medication-assisted treatment (MAT), residential and outpatient addiction programs, and outpatient counseling, with precise coding and claims management.
Physical, Occupational, and Speech Therapy – Therapy session billing, modifier application, EMR integration, and outcome-based reporting for therapy providers.
Surgical and Hospital-Based Practices – General surgery, anesthesia, cardiology, orthopedics, gastroenterology, urology, and other hospital specialties requiring detailed charge capture, post-op claims management, and global period tracking.
Chiropractic and Pain Management – Interventional pain procedures, spinal manipulations, and physical medicine services with session-based billing and treatment plan documentation.
Urgent Care and Walk-In Clinics – E/M code validation, same-day billing, and high-volume claim processing for urgent care centers and independent clinics.
Imaging, Laboratory, and Diagnostic Services – Radiology, pathology, laboratory, and outpatient diagnostic centers, including management of professional and technical components.
Dental and Ancillary Services – Coordination of dental-to-medical claims, durable medical equipment (DME) billing, and ambulatory surgical center claims requiring multi-payer submissions.
Community Health Centers and FQHCs – Federally Qualified Health Centers, rehabilitation hospitals, and outpatient community clinics, including program-funded and bundled service billing.
Specialized Outpatient and Facility-Based Services – Behavioral therapy clinics, outpatient surgical centers, and rehabilitation facilities, with detailed claims tracking, reporting, and revenue oversight.
Other Specialty Practices We Support – Cardiology, gastroenterology, orthopedics, neurology, endocrinology, dermatology, urology, ophthalmology, ENT, general surgery, interventional radiology, and other outpatient or hospital-based specialty services.

Whether a practice focuses strictly on primary care or operates as a multi-specialty organization, MZ Medical Billing Services ensures accurate coding, payer compliance, detailed claim-level tracking, and consistent revenue performance across all lines of care.

Applied Behavior Analysis

Behavioural Health

Pediatric

Mental Health

Physical Therapy

Occupational Therapy

Speech Therapy

Anesthesiology

Radiology

Gynecology

Ambulatory

Urgent Care

Neuorology

Orthopedics

Cardiology

Chiropractic

Opthalmology

Oncology

Dental

Gastroentrology

What MZ Medical Billing LLC Does for Primary Care Practices

We do not use a one-size-fits-all approach. Primary care practices have distinct billing needs, and we structure our processes to meet them while following Medicare, Medicaid, and commercial payer rules.

CPT and ICD-10 Coding Accuracy

Our team handles coding for family medicine, pediatrics, geriatrics, OB/GYN, and multi-provider primary care clinics. We assign the correct CPT codes for routine visits, chronic care management, preventive services, and complex cases. ICD-10 diagnosis codes are precise, support medical necessity, and reduce claim rejections.

Claim Review and Submission

Every claim is reviewed for coding errors, missing information, and correct payer details. Claims are submitted only after verification to avoid denials and delays in payment.

Denial Review and Appeals

Denied claims are tracked and analyzed. Errors are corrected, and claims are resubmitted or appealed. We monitor denial patterns to address recurring issues and recover revenue.

Insurance Credentialing

We assist with credentialing and payer enrollment for all major insurers. This ensures practices can bill immediately without delays or interruptions.

Patient Statements and Collections

We prepare clear, accurate patient statements and follow up on unpaid balances. Collections are conducted professionally to maintain patient relationships.

Billing Audits and Compliance Checks

Regular coding audits and charge reviews ensure claims meet payer rules and CMS guidelines. We follow HIPAA and documentation standards to maintain compliance.

EMR and Practice Management Integration

We connect with EMR and billing systems to streamline claim submission, reduce errors, and provide accurate reporting.

Reporting

Practices receive reports showing billed amounts, payments collected, denials, and accounts receivable. This provides visibility into financial performance and identifies areas needing attention.

Certified Staff

Our team is certified through AAPC and AHIMA and stays updated on CPT, ICD-10, and payer rules to ensure accurate billing.

MZ Medical Billing LLC supports primary care practices in getting claims paid correctly and on time, reducing administrative burdens, and maintaining compliance with payer requirements.

Ready to Fix Your Primary Care Billing and Increase Your Revenue?

Your practice works hard every day to take care of patients. Your billing should work just as hard to take care of your bottom line. MZ Medical Billing LLC is here to make that happen.

Contact us today for a free billing review. We will look at your current process, find where money is being lost, and show you exactly how we can help. There is no obligation, just a clear picture of what better billing can do for your practice.

Call us or fill out our contact form to get started.

FAQS

Primary Care Billing FAQs

How can we reduce denials due to coding errors in primary care?

We handle billing for all primary care and internal medicine services including office visits, annual wellness visits, preventive care, chronic disease management, care coordination, minor procedures, point-of-care testing, vaccine administration, and more. If your practice does it, we can bill for it.

Should we verify patient insurance eligibility before every visit?

Yes. Verifying eligibility at scheduling and again at check‑in prevents claims from being denied because coverage changed or expired. Real‑time eligibility systems or verification tools in your EMR can help automate this step.

What’s the difference between a claim rejection and a denial?

A rejection means the clearinghouse or payer won’t even process the claim because of errors (missing info, invalid ID). A denial means the payer processed the claim but won’t pay because of coding, medical necessity, or policy issues. Practices should fix and resubmit rejections and appeal denials.

How important is correct diagnosis coding in primary care claims?

Very important. If a diagnosis code is too generic or doesn’t match the service (e.g., chronic hypertension billed as “unspecified”), payers may deny the claim. Accurate diagnostic coding tells the payer exactly why services were provided.

Can prior authorization affect primary care billing?

Yes. Certain services, even some labs, imaging, or procedures ordered by a primary care provider, may require prior authorization. Claims submitted without required authorization are likely to be denied.

What responsibilities do clinics have when billing multiple payers?

If a patient has more than one insurance plan, practices must coordinate benefits, bill the correct primary payer first, and then bill the secondary. Errors in payer order often lead to denials or delayed payments.

How can patient balances be managed to reduce unpaid accounts?

Verifying patient responsibility (deductibles, co‑pays, coinsurance) upfront and providing cost estimates helps patients understand what they owe. Clear statements and professional follow‑up increase collection rates.

Is internal audit of billing processes necessary?

Yes. Regular internal audits help identify missing documentation, inconsistent coding, and repeated errors that cause denials. Audits also help ensure compliance with payer and CMS billing rules.

What are the risks of incorrect place‑of‑service or modifier errors?

Incorrect place‑of‑service codes (e.g., telehealth vs. office) or wrong modifiers can cause automatic denials because payers have strict rules about when services qualify for reimbursement. Practices must track payer‑specific rules carefully.

What documentation is needed to justify Primary Care E/M billing?

Primary care documentation must reflect the level of history, exam, and medical decision‑making, or time spent on the encounter. It must support the CPT level billed and show medical necessity. Poor documentation leads to denials or underpayment.

What types of primary care services do you handle billing for?

What are the most common reasons primary care claims get denied?

Primary reasons include incomplete patient details (name, insurance ID), missing or incorrect diagnosis or procedure codes, failure to verify eligibility, and missing prior authorizations. These mistakes frequently lead to denials and payment delays.

How do you make sure the right E&M codes are used?

Our billing team reviews the documentation from each visit and matches it to the correct E&M code based on medical decision making and time. We follow the latest AMA and CMS guidelines to make sure every code is supported and accurate.

Can you help if our practice has a high denial rate right now?

Yes. A high denial rate is usually a sign of coding errors, missing documentation, or credentialing issues. We will review your denied claims, find the root cause, and fix the problem, then work to recover what was denied.

Do you work with all insurance companies?

We work with all major commercial insurance payers as well as Medicare and Medicaid. If your patients have it, we know how to bill it.

How long does it take to start seeing results after switching to MZ Medical Billing LLC?

Most practices start seeing cleaner claims and faster payments within the first 30 to 60 days. Denial rates typically drop within the first few months as we clean up coding and submission issues.

Will we lose control of our billing if we outsource it to you?

No. You stay in full control. We handle the work, but we give you regular reports and updates so you always know exactly what is happening with your revenue. Nothing is hidden.

How do you handle billing for chronic care management services?

Chronic Care Management and Principal Care Management are often missed by practices. We identify patients who qualify, make sure the required time and documentation are in place, and bill these services correctly every month so your practice captures the revenue it has earned.

Do you handle pediatric and geriatric billing differently from standard adult visits?

Yes. Pediatric billing follows VFC guidelines and age-based coding rules. Geriatric billing involves complex Medicare rules and multi-condition management. We have separate expertise in both and apply the right rules for each patient population your practice serves.

What if a healthcare provider at our practice is not yet credentialed with certain payers?

We offer credentialing support to help healthcare providers get enrolled with the insurance companies they need. We manage the paperwork and follow up with payers so the process moves as fast as possible.

How is your pricing structured?

We typically charge a percentage of collections, which means we only make money when you make money. There are no large upfront fees. Contact us for a custom quote based on your practice size and specialty.