Solo Practice Medical Billing Services

When you are the only provider, there is no billing department between you and your unpaid claims.

A denied claim, an authorization problem, or an aging A/R balance can sit until you find the time to deal with it. Meanwhile, you are seeing patients, completing documentation, managing staff, and handling the day-to-day demands of the practice.

That creates a billing problem specific to solo practices: when billing falls behind, there may be nobody else to pick it up.

MZ Medical Billing takes ownership of the revenue cycle behind your practice. We handle the work from eligibility and authorization through coding, claim submission, payment posting, denials, appeals, and A/R follow-up.

You keep your existing EHR, practice management system, payer relationships, and day-to-day workflow. Our team fits right into your current setup without forcing you to rebuild your practice around a new billing process.

If your current workflow has gaps, bottlenecks, or unnecessary steps, we can also help optimize it. We review how information moves through your practice, identify where claims or payments are getting held up, and recommend practical changes that can make the billing process work better.

Your practice stays intact. Your billing gets the support it needs, and your existing setup can get better in the process.

You get a billing company that handles your revenue cycle, works with your existing systems and payers, and helps improve the way your billing works.

Talk to a Solo Practice Billing Specialist

Tell us about your practice, specialty, and EHR, and our team will get back to you with a billing plan built for your solo practice. Quick response.

Certified Coders

24-Hour Submission

Any EHR

Dedicated Manager

One Billing Team for Your Entire Revenue Cycle

Your revenue cycle starts before a claim is created. MZ Medical Billing handles the billing work across each stage, so tasks do not get split between different vendors or left for your practice to pick up later.

Before the Visit

We work on the information needed before the patient is seen and the claim is created.

Eligibility and benefits verification
Prior authorization
Credentialing and payer enrollment
Patient information review

After the Visit

Once the encounter is complete, we turn the visit into a clean, billable claim.

Charge entry
CPT, HCPCS, and ICD-10 coding
Documentation review
Claim scrubbing
Electronic claim submission

After the Claim

Submitting the claim is only the start. We track what happens after submission and work outstanding claims through payment.

Payment posting
ERA/EFT reconciliation
Denial management
Appeals
A/R follow-up
Underpayment review

Patient Balances

When a balance remains with the patient, we handle the billing work that follows.

Patient statements
Patient billing
Payment plan support
Patient billing inquiries

One billing team can manage the revenue cycle from the patient’s insurance check before the visit through final payment.

Billing Risks That Hit Solo Practices Harder

Every practice goes through the same billing steps, from eligibility checks before the visit to patient balances after payment. What changes in a solo practice is the exposure. In a group, one billing problem usually affects one provider’s claims. With a single provider, every payer and every claim runs through one record, so the same problem can stop the entire revenue stream. These are the places that happens.

Individual vs. Group NPI

Claims have to go out under the NPI and tax ID each payer has on file. If you bill under an individual NPI, a group NPI, or both, a mismatch with your enrollment can cause denials.

Credentialing and Revalidation

Medicare enrollment has to be revalidated about every five years, and commercial payers run their own recredentialing cycles. Miss a deadline and Medicare can deactivate your billing privileges, with no payment for services during that period. With one provider, that affects every claim.

Payer Enrollment

A new payer or a new location isn’t billable until the enrollment is approved. With no second provider to keep billing in the meantime, a delay is lost revenue.

Medicare Participation

Participating or non-participating status changes your Medicare payment rate and how you collect from patients. It’s a decision to revisit each year.

Coverage and Locums

When you’re out, Medicare lets you bill a substitute physician’s services under your NPI for up to 60 continuous days. After that, the substitute has to bill under their own NPI. Commercial payers set their own rules, so coverage should be arranged with each payer before you’re out.

A/R Dependency

With one provider, a few slow or denied claims can make up a large share of your cash flow, so even a small backlog shows up quickly.

Authorization

A missed authorization on a high-value service means a full denial, and there is no other provider’s schedule to absorb the loss.

EHR Workflow

Unsigned notes, missing charges, and incomplete documentation hold claims before they’re submitted. These are the gaps we look for when we review how information moves from your EHR to the claim.

Credentialing, payer enrollment, revalidation tracking, prior authorization, A/R follow-up, Medicare participation guidance, and locum coverage planning are all part of the work we handle. Payer-specific enrollment steps, coding, and denial detail are covered further down the page and on our supporting pages.

What You Get When You Outsource Your Billing to MZ

A solo practice usually has one biller, or none, and billing waits for whoever has time. When you outsource to MZ, you get the staffing of a billing department without hiring one. Here is what that means in practice.

A Billing Team, Not One Biller

Your account is worked by specialists, each handling the part of the cycle they know best:

AAPC- and AHIMA-certified coders for charge coding and documentation review
Billing specialists for claim submission and payment posting
Denial specialists for appeals and underpayments
Credentialing support for enrollment, revalidation, and payer updates
An account manager who runs your account

If one person is out, your billing doesn’t stop.

One Point of Contact

Your account manager is the person you call. They know your practice, your payers, and your open claims. They answer billing questions, bring you what needs your attention (a missing signature, a denial that needs clinical documentation, an authorization that requires your input), and coordinate the rest of the team so you aren’t chasing five people.

Your Existing EHR

We work inside the EHR and practice management system you already use. You don’t replace software, retrain staff, or change how you document.

Daily Claim Management

Claims are submitted and worked every business day, not in a batch when someone gets to them. Rejections are corrected and resubmitted as they come in, and denials are reviewed when they arrive, so a problem doesn’t age for weeks before anyone sees it.

A/R Ownership

Unpaid claims are our job. We follow each one with the payer until it is paid, appealed, or resolved, and we work aging balances in order instead of waiting for them to become write-offs. You don’t track what is outstanding or decide which claim to chase next.

Monthly Reporting

Each month you receive a report showing:

Claims submitted and payments collected
Denials and the reasons behind them
A/R aging by payer
Outstanding balances and what we are doing about them

You see where your revenue stands without logging into anything or asking.

How Getting Started with MZ Works

Switching, Starting Out, or Handing Off Your Own Billing

Solo practices come to MZ from three places: another billing company, a brand-new practice, or the provider’s own desk. The steps are the same for all three, and only the starting point changes. Most of the work falls on our side, and your part is mainly granting access and answering questions.

1. Free Billing Audit

We start by looking at where your billing stands, so we know what we’re taking on before we change anything.

Switching from a billing company: We review your A/R, denials, collections, payer mix, coding, and current workflow.
Doing your own billing: We review the same items, and we look for claims that were never submitted, denials that were never worked, and balances that have aged out.
New practice: There is no history to audit, so we review your setup instead, including your NPI, tax ID, payer mix, EHR, and which payers you need to be enrolled with.

2. Billing Handoff

We collect what we need to bill on your behalf. You don’t assemble a binder. We tell you what we need and help you find it.

Payer information
EHR access
Clearinghouse information
Fee schedules and payer contracts, where applicable
Your existing A/R
Your current billing workflows

When you are leaving another billing company, we request your claim and A/R data from them, and you tell us your end date so claims don’t go unworked during the handoff. When you have been billing yourself, we work from your practice management system and payer portals. A new practice starts with enrollment and credentialing, so claims can go out as soon as payers approve you.

3. System Setup

We connect to the systems you already use, so nothing on your side gets replaced.

Your EHR
Your practice management system
Your clearinghouse
ERA and EFT, so payments post correctly

New practices often don’t have a clearinghouse or practice management system yet. We help you set them up.

4. Claims Start Moving

Once the connections are in place, claims go through our process: coding, scrubbing, submission, payment posting, and follow-up. Any existing A/R is worked at the same time, so older balances don’t wait behind new claims.

5. Ongoing Management

After the transition, billing is managed on a regular schedule. You receive:

Monthly reports
Account support from your account manager
Denial trends, so recurring problems get fixed at the source
A/R status
Collection information

Your practice runs the way it does now. The billing work moves to us.

Payer Specific Billing for Solo Practices

MZ Medical Billing bills every major insurance payer that solo practices and independent physicians work with across the United States. From Medicare and Medicaid to Medicare Advantage, commercial insurance, Blue Cross Blue Shield plans, ACA marketplace plans, Tricare, VA Community Care, workers’ compensation, and auto insurance, our billing team knows each payer’s rules for claim submission, prior authorization, telehealth billing, timely filing, and appeals.

For a solo practice, payer mix decides cash flow. One payer may pay in two weeks, while another holds claims for two months. One plan may need prior authorization for a service that another plan pays without question. One payer may bundle codes that another pays separately. Our payer-specific billing process follows each insurance company’s own rules, so your claims get paid faster and with fewer denials.

Medicare and Medicare Administrative Contractors (MACs)

We bill Original Medicare Part B for solo physicians through every Medicare Administrative Contractor, including Noridian, Novitas Solutions, Palmetto GBA, National Government Services (NGS), Wisconsin Physicians Service (WPS), CGS Administrators, and First Coast Service Options. We also handle Railroad Medicare claims. Our coders follow each MAC’s Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), Medicare Physician Fee Schedule rules, and NCCI edits. We bill Medicare-specific codes such as G2211, APCM, annual wellness visits, chronic care management, and remote patient monitoring correctly, and we handle Medicare secondary payer (MSP) rules and crossover claims to Medigap and Medicare supplement plans.

Medicare Advantage Plans

Medicare Advantage now covers a large share of Medicare patients, and these plans often have stricter prior authorization rules and slower payments than Original Medicare. We bill Medicare Advantage plans from UnitedHealthcare, Humana, Aetna, Cigna, Anthem, Wellcare, Devoted Health, Alignment Health, Clover Health, SCAN Health Plan, Kaiser Permanente Senior Advantage, and regional Blue Cross Blue Shield Medicare plans. We also support accurate HCC risk adjustment coding under the CMS-HCC V28 model, so your patients’ RAF scores reflect their true health status and your Medicare Advantage revenue stays protected.

Medicaid and Medicaid Managed Care Plans

Medicaid billing changes from state to state, and most states now run Medicaid through managed care organizations (MCOs). We bill state Medicaid programs and Medicaid managed care plans, including Molina Healthcare, Centene, Ambetter, Wellcare, Anthem Medicaid, Amerigroup, Aetna Better Health, UnitedHealthcare Community Plan, CareSource, AmeriHealth Caritas, Superior HealthPlan, Sunshine Health, Fidelis Care, Healthfirst, and Meridian. We track state-specific eligibility rules, Medicaid prior authorization, referral needs, and dual-eligible billing for patients covered by both Medicare and Medicaid.

Blue Cross Blue Shield Plans

Blue Cross Blue Shield is not one payer. It is a network of independent plans, each with its own policies, fee schedules, and portals. We bill BCBS plans nationwide, including Anthem Blue Cross Blue Shield, Elevance Health, Highmark, Florida Blue, Blue Cross Blue Shield of Texas, Blue Cross Blue Shield of Illinois, Blue Cross Blue Shield of Michigan, Horizon BCBS of New Jersey, Independence Blue Cross, CareFirst BlueCross BlueShield, Excellus BCBS, Regence, Premera Blue Cross, Wellmark, Blue Shield of California, and the BlueCard program for out-of-state Blue members.

Commercial Insurance Payers

We bill all major commercial health insurance plans, including UnitedHealthcare, Optum, Oxford Health Plans, Aetna, Cigna, Humana, Kaiser Permanente, Oscar Health, Health Net, EmblemHealth, Medica, Priority Health, Harvard Pilgrim, Tufts Health Plan, Point32Health, Geisinger Health Plan, UPMC Health Plan, Health Alliance Plan (HAP), Quartz, Dean Health Plan, and many regional and local commercial plans. For each plan, we follow its medical policies, bundling edits, modifier rules, and claim deadlines, and we compare every payment to your contracted rate to catch underpayments.

ACA Marketplace and Exchange Plans

Many solo practice patients carry Affordable Care Act marketplace plans with high deductibles. We bill exchange plans from Ambetter, Oscar, Blue Cross Blue Shield, Aetna CVS Health, Cigna, Molina Marketplace, and UnitedHealthcare. We verify eligibility and grace-period status before visits, since marketplace coverage can lapse when premiums go unpaid, and we help your practice collect patient responsibility early.

Tricare and Military Health Plans

We bill Tricare Prime, Tricare Select, and Tricare For Life through regional contractors, including Humana Military for the East Region and TriWest Healthcare Alliance for the West Region. We follow Tricare referral and authorization rules and coordinate Tricare For Life claims as secondary to Medicare.

VA Community Care and CHAMPVA

Solo practices that see veterans can bill through the VA Community Care Network, which is managed by Optum and TriWest depending on the region. We also bill CHAMPVA for eligible family members of veterans. VA billing needs a valid referral and authorization for each episode of care, and we track these closely so claims do not get denied.

Workers’ Compensation Insurance

Workers’ comp billing follows state fee schedules and needs strong documentation of the work injury. We bill workers’ compensation carriers and third-party administrators, including Travelers, Liberty Mutual, The Hartford, Zenith Insurance, AmTrust, Employers Holdings, State Compensation Insurance Fund, Sedgwick, and Gallagher Bassett. We handle claim numbers, adjuster communication, and medical records requests.

Auto Insurance and Personal Injury (PIP) Claims

We bill auto insurance and personal injury protection (PIP) claims for solo practices that treat accident patients, including State Farm, GEICO, Progressive, Allstate, USAA, Farmers, Nationwide, and Liberty Mutual. We also support letter of protection (LOP) cases and coordinate with attorneys when needed.

Medicare Supplement, Secondary, and Coordination of Benefits

Many solo practice patients have more than one plan. We handle coordination of benefits (COB), secondary and tertiary claims, Medigap crossover claims, and Medicare secondary payer questionnaires. Correct COB billing stops one of the most common causes of payer delays and denials in small practices.

Self-Pay and Uninsured Patients

For uninsured and self-pay patients, we help your practice provide Good Faith Estimates under the No Surprises Act, set up fair payment plans, and follow up on balances in a respectful way that protects your patient relationships.

Why Payer-Specific Billing Matters for Solo Practices

Every payer has different timely filing limits, prior authorization rules, telehealth policies, place of service rules, modifier requirements, and bundling edits. A claim that pays from one insurance company can be denied by another for the same service. Large groups have staff who specialize in each payer. Solo practices usually do not. Our team brings that payer knowledge to your practice.

We check every Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) against your payer contracts and fee schedules. When a payer underpays, applies the wrong adjustment, or denies a valid claim, we appeal it. We also help you review payer contracts, see which plans pay best for your services, and plan credentialing with new payers to grow your patient base.

Small practices often accept whatever a payer sends because there is no time to fight it. We do not. Every dollar your solo practice earns from Medicare, Medicaid, Medicare Advantage, commercial insurance, and every other payer is followed until it is paid in full.

Billing Rules That Work Differently for Solo Practices

Solo practices follow the same payer rules as large groups, but several billing, enrollment, and reporting rules apply to them in specific ways. We set up and manage each one for your practice.

Type 1 and Type 2 NPI Setup

Many solo physicians bill under an individual NPI (Type 1), while others form a professional corporation and bill under a group NPI (Type 2). The wrong setup on claims, payer contracts, or ERA enrollment causes rejections and payments sent to the wrong account. We match your NPI, Tax ID, and payer enrollments correctly.

MIPS Reporting for Small Practices

Practices with 15 or fewer clinicians get special MIPS rules, including small practice bonus points, reduced reporting options, and hardship exceptions. Solo physicians who skip MIPS or report incorrectly face a negative payment adjustment on Medicare Part B claims. We check your eligibility, low-volume threshold status, and reporting needs each year.

Incident-To Billing for NPs and PAs

Solo physicians who add a nurse practitioner or physician assistant can bill some follow-up visits under the physician’s NPI at the full fee schedule rate, but only when direct supervision and plan-of-care rules are met. Wrong incident-to billing is a common audit target. We bill under the correct provider every time.

Medicare Participation Status

Solo physicians choose between participating (PAR), non-participating (non-PAR), or opting out of Medicare. Each choice changes payment rates, assignment rules, and limiting charges on patient bills. We bill according to your status and help you review which option fits your practice.

Single-Provider Enrollment Dependency

In a solo practice, every claim depends on one provider’s enrollment record. One address change not updated in PECOS, one missed revalidation, or one payer directory error can stop all payments at once. We monitor your enrollment records with every payer and update them before problems start.

Reciprocal Billing Arrangements

Besides paid locum coverage, solo physicians often trade coverage with a nearby colleague. These informal arrangements are billed with modifier Q5 and have their own time limits and rules. We bill shared coverage correctly so neither physician faces denials or compliance issues.

Should You Hire a Biller or Use an Outsourced Medical Billing Company?

For a solo practice, hiring one in-house biller can seem like the simplest option. You have someone sitting in your office who handles claims, payments, and payer calls. But your entire billing operation can end up depending on one employee’s availability, experience, and workload.

An outsourced medical billing company gives your practice access to a broader billing team without having to hire and manage each role yourself.

	In-House Biller	Outsourced Medical Billing Company
Hiring	You recruit, interview, and hire the biller	No billing employee to recruit
Payroll & Benefits	Salary, payroll taxes, benefits, PTO, and other employment costs	Included in the billing service
Billing Coverage	Billing depends largely on one employee	A team can handle billing, coding, denials, A/R, and other functions
Coding Expertise	Depends on the employee’s training and experience	Access to certified coding specialists
Denial Management	Denials compete with the biller’s other daily tasks	Denial work is handled as part of the billing workflow
A/R Follow-Up	Limited by one person’s available time	Dedicated A/R follow-up and payer communication
Credentialing	May require separate staff or outside help	Credentialing support can be included when needed
Training & Updates	You are responsible for ongoing training and education	The billing company manages its team’s billing and coding knowledge
Employee Absence	Vacation, illness, or turnover can interrupt billing	Billing continues through the wider team
Scalability	More work may require another employee	Additional billing support can be handled without another hire
Software & Systems	Practice manages the billing setup and related tools	The billing company works within your existing billing workflow and EHR
Management	You manage the employee and their workload	You work with the billing company while its team manages the billing work

The Difference for a Solo Practice

With an in-house biller, you are not simply paying someone to submit claims. You are taking responsibility for an entire employee and the billing operation that depends on them.

With an outsourced medical billing company, you can hand off the revenue cycle work to a team that handles the day-to-day billing process while you remain focused on your patients and practice.

That can include eligibility verification, prior authorization, coding, claim submission, payment posting, denial management, appeals, A/R follow-up, credentialing, and patient billing, depending on the services your practice needs.

When an In-House Biller May Make Sense

An in-house biller can make sense for a practice that wants billing handled directly within the office and has enough volume to support the ongoing employment cost and workload.

But if you are a solo provider who does not want your billing to depend on one employee, building an internal billing department may not be necessary.

When an Outsourced Medical Billing Company May Be the Better Fit

Outsourcing may make more sense if you:

Are currently handling billing yourself
Have one biller managing too many responsibilities
Are dealing with an aging A/R backlog
Have claims or denials that are not being followed consistently
Need coding and billing expertise without hiring additional staff
Are opening a new solo practice
Are moving away from an existing billing company
Are leaving a hospital or larger medical group to practice independently
Need credentialing and billing support for a single provider
Want to keep using your existing EHR and practice management system

The goal is not simply to replace one biller with another. It is to give your solo practice access to the people and processes needed to keep the entire revenue cycle moving.

Solo Practice Billing Codes: CPT, HCPCS, and Modifiers

Most solo practices bill a core group of evaluation and management codes along with add-on, care management, and preventive codes. Missing or misusing these codes is one of the biggest causes of lost revenue in small practices. Below are the codes our coders work with every day for solo physicians.

Office and outpatient E/M visits

99202–99205 — New patient office visits, coded by medical decision making or total time
99211–99215 — Established patient office visits
99417 / G2212 — Prolonged services for visits that go beyond the time threshold (commercial vs. Medicare)
G2211 — Visit complexity add-on for ongoing, longitudinal care of a patient’s serious or complex condition

Care management codes

G0556–G0558 — Advanced Primary Care Management (APCM), billed monthly based on patient complexity
99490 / 99439 — Chronic care management by clinical staff
99491 / 99437 — Chronic care management by the physician
99495 / 99496 — Transitional care management after a hospital discharge
99484 — Behavioral health integration services

Remote monitoring codes

99453 — Remote patient monitoring device setup and patient education
99454 — RPM device supply for 16–30 days
99445 — RPM device supply for 2–15 days (new for 2026)
99457 / 99458 — RPM treatment management, first 20 minutes and each added 20 minutes
99470 — RPM treatment management, first 10 minutes (new for 2026)
98975–98981 — Remote therapeutic monitoring, with new 2026 codes for shorter supply and management time

Preventive and wellness codes

G0402 — Welcome to Medicare preventive visit
G0438 / G0439 — Initial and subsequent Annual Wellness Visit
99381–99397 — Preventive medicine visits by age
99497 / 99498 — Advance care planning

Common modifiers for solo practice billing

25 — Separate, significant E/M service on the same day as a procedure
95 — Synchronous telehealth service
59 / XE, XS, XP, XU — Distinct procedural service
Q6 — Service furnished by a locum tenens physician under a fee-for-time arrangement
GT, FQ, FR — Telehealth and audio-related modifiers depending on payer rules

Correct E/M level selection, add-on code capture, and modifier use make a real difference in a solo practice’s yearly collections. Our AAPC-certified coders match every code to your documentation, so you are paid fully for the work you do and stay protected in an audit.

Our Solo Practice Medical Billing Services

A solo practice needs more than claim submission. It needs every part of the revenue cycle handled with care, from the moment a patient books an appointment to the day the final balance is paid. Our solo practice medical billing services cover each of these steps, so your single-provider practice gets the same depth of support that large groups get from a full in-house department.

Our services are grouped around the full billing journey. Front-end services like insurance verification, prior authorization, and provider credentialing stop problems before a visit takes place. Mid-cycle services like medical coding, claim submission, and telehealth billing turn your documentation into clean, accurate claims. Back-end services like payment posting, denial management, appeals, A/R recovery, old A/R cleanup, and write-off recovery follow every dollar until it is collected. Patient-facing services like patient billing and our Patient Help Desk keep your patients informed and your front desk free. Growth and operations services like practice management, virtual assistance, healthcare digital marketing, and EHR/EMR data migration help your independent practice run smoothly and attract new patients.

You can choose a single service to fix a specific problem, such as a large A/R backlog or a credentialing delay, or combine several into full revenue cycle management for your solo practice. Each service below is shaped for one-provider practices, with clear workflows, a dedicated point of contact, and support from certified billing and coding specialists.

Medical Billing Services

We manage complete medical billing for solo practitioners, from charge entry to final payment. Your claims are scrubbed, submitted within 24 hours, and followed until paid. For a solo physician, this means steady cash flow without depending on one in-house biller, and a billing process that keeps running even when your office is short-staffed.

Medical Coding Services

Our AAPC-certified coders assign accurate CPT, ICD-10, and HCPCS codes for every visit. We select the correct E/M level, capture add-on codes like G2211 and prolonged services, and apply modifiers only where documentation supports them. Solo practices often undercode out of caution. We code to the full value of your documented work, safely.

Provider Credentialing Service

In a solo practice, one lapsed enrollment stops all revenue. We handle Medicare enrollment through PECOS, Medicaid enrollment, commercial payer credentialing, CAQH ProView setup, and 120-day re-attestations. We also track revalidation dates and payer contract renewals, so your single provider stays in-network and billable all year.

Revenue Cycle Management

We run your full revenue cycle management for small practices, from patient scheduling and eligibility checks to coding, claims, payment posting, denials, and collections. You get one connected process instead of scattered tasks. Solo practices benefit most from end-to-end RCM because every step is handled by specialists instead of overloaded staff.

Insurance Verification

We verify insurance eligibility and benefits before each appointment, including active coverage, copays, deductibles, coinsurance, referral needs, and authorization rules. This prevents eligibility denials and helps your front desk collect patient responsibility at check-in, which matters greatly for a solo practice’s daily cash flow.

Prior Authorization

Prior authorization takes hours from small practice staff every week. We handle submission, follow-up, and approval tracking for imaging, procedures, specialty medications, and referrals. Your patients get care on time, your staff gets time back, and your claims do not get denied for missing authorization.

Denial Management and Appeals

We review every denied claim, find the root cause, correct it, and resubmit quickly. We also track denial trends by payer and CARC code so the same mistake does not repeat. Solo practices often leave denials unworked because nobody has time. We work every one.

Payment Posting and Reconciliation

We post ERA and manual payments accurately, match each payment to the claim, and flag underpayments, incorrect adjustments, and unpaid line items. Accurate payment posting gives a solo physician a true picture of practice income and catches payer underpayments that would otherwise go unnoticed.

Accounts Receivable (A/R) Follow-Up

We work your aging A/R by priority, following up with payers on unpaid and stuck claims before timely filing limits pass. Lower days in A/R means money reaches your account sooner. For a solo practice, faster A/R recovery directly improves monthly cash flow.

Solo Practice Revenue Cycle Management Process

Our solo practice revenue cycle management process connects every step, from insurance verification and medical coding to claim submission, payment posting, and denial management, into one steady workflow. Built for independent physicians, it fits your existing EHR, keeps claims moving daily, and delivers a higher clean claim rate, lower days in A/R, and stronger collections.

Free Revenue Audit

We review your current collections, denial rate, clean claim rate, days in A/R, and coding patterns. You see exactly where your practice is losing money before you commit.

Smooth Onboarding

We connect with your EHR and practice management system, set up clearinghouse and ERA/EFT enrollment, and build workflows around your schedule. There is no gap in billing during the switch.

Front-end accuracy

We verify insurance eligibility, handle prior authorizations, and confirm patient data before visits, which stops denials before they start.

Coding and claim submission

Certified coders review documentation, assign accurate codes, scrub claims, and submit within 24 hours.

Payment posting and follow-up

We post payments, flag underpayments, work denials, file appeals, and follow up on every unpaid claim.

Regular Reporting and Improvement

You receive clear reports on collections, net collection rate, denial trends, and A/R aging, with a dedicated account manager to answer questions

Solo Practice Billing Across All Medical Specialties

Solo practices come in many forms. A solo psychiatrist, a single-provider pediatric office, an independent physical therapist, and a one-surgeon orthopedic clinic all run as small businesses, but their billing has very little in common. Each specialty uses its own CPT and HCPCS codes, documentation rules, payer policies, and denial patterns. Our team knows how independent physicians in each specialty earn revenue and where small practices most often lose it.

Independent therapists and psychiatrists often bill alone, without front desk support for authorizations or session tracking. Our behavioral health billing and mental health billing services handle psychotherapy time thresholds, interactive complexity and crisis add-ons, E/M plus psychotherapy pairing, visit limits, and carve-out behavioral health payers, so a solo clinician gets paid for every session without chasing approvals between appointments.

Solo pediatricians carry heavy preventive volume with thin margins on vaccines. Our pediatric billing team captures age-based preventive visit codes, counseling-based vaccine administration codes, sick-and-well same-day billing with modifier 25, VFC program rules, and Medicaid and CHIP eligibility, so a small pediatric office stops losing money on immunizations and split visits.

Independent therapy clinics depend on accurate unit billing to stay profitable. For physical therapy billing, occupational therapy billing, and speech therapy billing, we apply the 8-minute rule, GP, GO, and GN modifiers, KX threshold tracking, progress report timing, and certified plan-of-care rules that payers audit closely in small private practices.

Solo radiologists and independent imaging providers need clean split billing. Our radiology billing team bills professional and global claims with modifiers 26 and TC, confirms advanced imaging authorizations, and checks medical necessity against payer criteria. Independent OB/GYN practices face complex pregnancy billing, and our OB/GYN billing service handles global obstetric packages, partial care billing when patients transfer, high-risk visits outside the global, and gynecology procedures.

Single-surgeon and physician-owned surgical settings rely on precise procedure billing. Our ASC billing and anesthesia billing services cover multiple procedure discounting, device and implant billing, base units plus time units, medical direction modifiers such as AA, QK, and QZ, and payer-specific ASC payment rules. Independent walk-in clinics need speed at the front desk, and our urgent care billing team handles real-time eligibility, S9083 and S9088 payer rules, E/M leveling, and in-clinic procedures like laceration repair and splinting.

Many solo specialists bill high-value diagnostics and procedures from a single office. Our cardiology billing captures echocardiography, stress testing, Holter and event monitoring, and device checks. Our orthopedics billing handles surgical global periods, joint injections, DME supplies, and RT and LT modifiers. Our ophthalmology billing separates medical eye exams from routine vision plans and bills eye exam codes against E/M correctly. Our oncology billing covers J-code drug units, infusion hierarchy, and wastage with the JW and JZ modifiers. Our dental billing supports solo dentists with CDT coding, ADA claim forms, and dental-to-medical cross-coding.

Independent specialists in procedure-heavy fields also benefit from focused support. We provide neurology billing for EEG, EMG, and nerve conduction study coding, gastroenterology billing for screening-to-diagnostic colonoscopy conversion with modifiers PT and 33, and pain management billing for epidural steroid injections, facet and nerve blocks, radiofrequency ablation, frequency limits, and prior authorization.

If your solo practice specialty is not on this list, reach out to us. We will look at your codes, payer mix, and current billing results, and tell you honestly whether our team is the right fit for your independent practice.

Medical Billing & RCM Services for Solo Practices Across All 50 States

MZ Medical Billing LLC provides solo practice medical billing and Revenue Cycle Management services to independent physicians, single-provider clinics, physician-owned practices, and small private practices across the United States. We work inside your existing EHR and practice management system, whether you run a cloud-based EHR, a specialty-specific platform, or a small practice setup with a separate billing system. We support solo physicians billing under an individual NPI, single-provider professional corporations, newly opened practices, and physicians who have recently left a hospital or group to go independent.

Our certified medical billing and coding specialists handle the complete billing workflow for one-provider practices, including patient demographic review, insurance eligibility and benefits checks, prior authorization, charge entry, CPT, HCPCS, and ICD-10-CM coding, claim scrubbing, clearinghouse rejection fixes, claim submission, denial management, appeals, 835 ERA payment posting, patient statements, and accounts receivable follow-up. We work with Medicare, Medicaid, Medicare Advantage, commercial payers, workers’ compensation, and no-fault insurance.

With MZ Medical Billing LLC, solo practices get a full billing team without hiring one, cleaner claims, steady payer follow-up, and clear monthly reports, all without changing their software. You stay in control of your practice and your patients while we manage the billing work behind it, so every service you provide is billed, followed, and paid.

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Why Choose MZ Medical Billing for Solo Practice Billing

Built for independent physicians

We understand the solo practice model, its cash flow pressure, and its staffing limits.

Full team, one fee

You get certified coders, billers, denial specialists, credentialing staff, and an account manager for a percentage of collections.

Pre-submission claim scrubbing

Every claim passes NCCI edits, LCD/NCD checks, and payer-specific rules before transmission to raise your first-pass resolution rate.

ERA-level underpayment tracking

We match each 835 remittance against your contracted fee schedule, flag CARC/RARC adjustment errors, and appeal short payments.

Get Started with Solo Practice Medical Billing Services

Your solo practice should not lose revenue to denials, missed codes, slow follow-up, or billing staff turnover. MZ Medical Billing gives independent physicians a complete billing team, accurate certified coding, fast claim submission, and full revenue cycle management, all at a cost that fits a small practice.

Start with a free revenue audit. We will review your collections, denial rate, and A/R, and show you exactly how much more your solo practice can collect. No pressure and no long-term lock-in, just clear numbers and a better billing process.

FAQS

Solo Practice Billing FAQs

Do I need a medical billing company for a solo practice?

You do not have to outsource your medical billing just because you operate a solo practice. You can handle billing yourself, hire an in-house biller, use billing software, or outsource some or all of the revenue cycle.

The question is how much of your time and practice resources you want tied up in billing.

Even a one-provider practice still has to deal with eligibility, authorizations, coding, claim submission, payment posting, denials, appeals, A/R follow-up, payer communication and patient balances. AMA identifies revenue-cycle work, prior authorization and other administrative responsibilities as significant burdens for private practices.

An outsourced medical billing company can take these tasks off your practice’s daily workload while giving you access to billing, coding, denial and A/R support without hiring each role separately.

How much does medical billing cost for a solo practice?

The cost depends on the billing company’s pricing model, the services included, your claim volume, specialty and the amount of revenue-cycle work your practice needs.

Common pricing models include:

Percentage of collections
Per-claim pricing
Flat monthly fees
Hybrid pricing

When comparing companies, look beyond the percentage or monthly fee. Ask what is included in the price and whether there are separate charges for setup, software, clearinghouse services, patient statements, credentialing, old A/R, or termination.

For example, MZ Medical Billing charges 2.99% of monthly collections, with a $200 administrative fee when monthly collections are below $10,000. Credentialing is separately priced at $149 per payer application after approval.

The important comparison is not simply “Who has the lowest percentage?” It is what billing work you receive for that fee and what additional costs you will have.

Is it cheaper to hire a biller or outsource medical billing?

An in-house biller’s salary is only part of the cost. A practice may also have payroll taxes, benefits, paid time off, recruiting, training, software, clearinghouse expenses and coverage issues when the employee is unavailable.

An outsourced medical billing company replaces the employment relationship with a billing service. Instead of managing one employee who handles your billing, you have access to a team that can divide responsibilities across coding, billing, denials, A/R and other revenue-cycle tasks.

For a solo practice, the better choice depends on your claim volume, budget, how much control you want internally and how much billing work you want to keep in the office.

Can I outsource medical billing if I'm a solo physician?

Yes. Medical billing companies work with single-provider practices as well as larger groups.

The important question is whether the company actually understands the workflow of a solo practice.

A solo practice may have one provider, one tax ID, one or more NPIs, a small administrative team and a payer mix that makes every unpaid claim important. Your billing process should account for those circumstances rather than simply applying a large-group workflow to a smaller practice.

Can a medical billing company work with my existing EHR?

In most cases, you do not need to replace your EHR simply because you outsource billing.

An outsourced medical billing company can work within your existing EHR or practice management system, provided the system supports the required billing workflow and access can be established.

Before choosing a billing company, ask:

Does it support my EHR?
Does it need separate billing software?
Who handles clearinghouse connectivity?
How are claims submitted?
How are ERAs received?
What access will the billing company have?
Can I still see my claims and reports?

MZ Medical Billing works within the practice’s existing EHR and practice management system rather than requiring a practice to replace its software.

Can a medical billing company work my old A/R?

Yes, many billing companies can work existing accounts receivable, but you should confirm this before signing a contract.

Old A/R requires a different approach from newly submitted claims. The billing team may need to review:

Claim history
Denial reason
Payment history
Filing deadlines
Appeals already submitted
Payer correspondence
Patient responsibility
Corrected claims
Outstanding balances

Ask whether old A/R is included in the standard billing fee or charged separately.

This is especially important when switching billing companies because an existing A/R backlog can contain revenue that has already been earned but has not yet been collected.

Why are my medical claims being denied?

Claims can be denied for many reasons, including:

Incorrect patient information
Eligibility problems
Missing authorization
Incorrect coding
Modifier errors
Medical-necessity requirements
Incorrect payer or plan
Credentialing or enrollment problems
Missing documentation
Timely-filing issues
Coordination-of-benefits problems

AMA notes that coding and billing errors contribute to unpaid claims, with commercial and Medicare claims remaining unpaid at 90 days in a significant portion of cases.

A billing company should not simply resubmit every denial. The denial reason needs to be identified, corrected where appropriate, documented and followed through to resolution.

Can a medical billing company take over from my current biller?

Yes. A solo practice can switch from an in-house biller or another billing company without starting its billing operation from scratch.

The transition should include a review of your current billing setup, outstanding A/R, payer information, clearinghouse configuration, EHR access, claim status and existing workflows.

Before switching, ask the new billing company:

Will you take over my existing A/R?
Who handles claims already submitted?
What happens to denied claims?
How will you transfer billing information?
Will claims continue during the transition?
How long will onboarding take?
What information do you need from my current biller?

A recent AMA article specifically notes that third-party billing can reduce administrative work for private practices, but physicians should perform due diligence and maintain clear contracts and oversight when selecting an outside billing company.

Can you help my solo practice bill G2211 and APCM codes?

Yes. We review your documentation and patient mix, set up correct workflows, and bill G2211 and APCM codes wherever they are earned and supported.

How long does medical credentialing take for a solo practice?

Credentialing timelines vary by payer, state, provider type and whether the application is complete.

A solo practice may need to complete:

CAQH setup and attestation
NPI enrollment
Medicare enrollment
Medicaid enrollment
Commercial payer enrollment
Group and individual provider enrollment where applicable
EFT/ERA enrollment
Payer directory updates
Revalidation and recredentialing

Start credentialing well before your planned opening date. A practice can be ready to see patients clinically but still be unable to bill a payer because enrollment has not been completed.

Can I open a solo practice and bill insurance right away?

Not necessarily.

Opening your office, obtaining your licenses and having an EHR does not automatically mean you are ready to bill every insurance payer.

You may still need payer enrollment and credentialing, appropriate NPI and tax information, EHR and clearinghouse setup, fee schedules and other payer-specific requirements.

The AOA specifically identifies failure to allow enough time for credentialing and enrollment as a common mistake when starting a medical practice.

Who follows up on unpaid medical claims?

Someone needs to own the claim after it leaves the clearinghouse.

A complete revenue-cycle process should include:

Claim submitted → payer response → rejection correction → payment → denial follow-up → appeal/correction → A/R follow-up → resolution

Ask a billing company exactly who handles unpaid claims and how often A/R is worked.

This matters because submitting claims is only one part of medical billing. A claim that was sent successfully but never followed up can still become lost revenue.

How do I bill Medicare as a solo physician?

Medicare billing depends on your provider enrollment, participation status, NPI/TIN configuration, specialty, services provided and the Medicare Administrative Contractor handling your claims.

A solo physician needs the appropriate Medicare enrollment and billing setup before submitting claims. Claims then need to meet Medicare coding, documentation, coverage and claim-submission requirements.

If you are starting a practice, your Medicare enrollment should be part of the startup plan rather than something handled after your first patient visit.

How do I bill Medicaid as a solo practice?

Medicaid billing is not one nationwide process. Requirements vary by state and may also differ among Medicaid managed care plans.

A solo practice may need to handle:

State Medicaid enrollment
Managed-care enrollment
Eligibility verification
Referrals
Prior authorization
State-specific billing requirements
Timely filing
Coordination with Medicare for dual-eligible patients

This is another reason to evaluate a billing company’s experience with the payer mix in the states where you practice.

How much time does prior authorization take for a physician?

There is no single amount of time because the workload depends on your specialty, payer mix, services and the number of patients requiring authorization.

For many practices, however, prior authorization is a substantial administrative task.

The work can include:

Determining whether authorization is required
Gathering clinical documentation
Submitting the request
Tracking the request
Responding to payer questions
Correcting incomplete requests
Appealing denials
Communicating with the patient

If your practice spends significant time on prior authorization, outsourcing this work can remove a recurring administrative task from your clinical and front-office staff.

Why am I getting paid less than I expected by insurance?

The amount a payer reimburses may differ from what your practice expected because of:

Contracted rates
Fee schedules
Patient responsibility
Contractual adjustments
Bundling
Modifier treatment
Multiple-procedure rules
Non-covered services
Incorrect payer processing
Claim-level adjustments

A proper payment-posting process compares the payer’s payment and adjustments against the expected reimbursement where the necessary contract and fee-schedule information is available.

If payments are consistently lower than expected, your practice should investigate the pattern rather than treating every underpayment as a normal adjustment.

How do I know if my medical billing company is doing a good job?

Do not judge a billing company only by how quickly it submits claims or by its percentage fee.

Ask for visibility into:

Claims submitted
Rejections
Denials
Denial reasons
A/R aging
Collections
Payment posting
Payer response times
Underpayments
Outstanding claims
Monthly revenue-cycle reports

You should also know who your point of contact is, how problems are escalated and what happens when a claim cannot be resolved on the first attempt.

What should I ask a medical billing company before hiring them?

Ask:

Do you work with my specialty?
Do you work with solo practices?
Which EHRs do you support?
What exactly is included in your fee?
Do you work denials and appeals?
Do you work old A/R?
Who handles credentialing?
Who will be my point of contact?
How often will I receive reports?
How do you monitor A/R?
How do you handle underpayments?
What happens during onboarding?
Will my billing continue during the transition?
Are there setup, software, clearinghouse or termination fees?
Can I see my billing data and reports?

How do you handle billing when I use a locum tenens physician?

We bill covered services under your billing number with the Q6 modifier and track the 60-day limit, so your income continues while you are away.

Will I still have control over my billing if I outsource?

Outsourcing billing does not mean giving up control of your practice.

You remain the practice owner and provider. The billing company handles the operational work you assign to it.

You should still have access to:

Your EHR
Billing reports
Claim information
A/R information
Payment information
Practice financial reports

Before signing, clarify what access you’ll have, what reports you’ll receive and who owns the underlying billing and patient data.

Will switching billing companies interrupt my cash flow?

No. We plan the transition, set up clearinghouse and ERA enrollment early, and keep claims moving during onboarding. We can also work your old A/R from the previous biller

Do you work with my EHR?

We work with most major EHR and practice management systems. If you are changing systems, our EHR/EMR data migration service moves your billing data safely.