Practice Growth Solutions
Revenue cycle, billing, and practice support built for modern healthcare teams
End-to-end billing support for claims, payments, AR, and reporting.
ICD 10 and CPT Coding Services Aligned with Clinical Documentation To Reduce Denials
Driving efficiency, compliance, and financial performance at scale
Increase Revenue from patient collections while reducing administrative workload.
we don’t just manage denials; we transform how healthcare organizations experience
We monitor, identify, and rectify critical errors to reduce revenue loss and compliance risk.
Simplify prior authorization services, save time, cut costs and boost revenue
Simplify prior authorization services, save time, cut costs and boost revenue
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Recovery Specialists
HIPAA Compliant
98% Claim Accuracy
30% Revenue Boost Avg
24h Turnaround
500+ US Practices
AI-Powered RCM
Denial Recovery Specialists
Recovery Specialists
HIPAA Compliant
98% Claim Accuracy
30% Revenue Boost Avg
24h Turnaround
500+ US Practices
AI-Powered RCM
Denial Recovery SpecialistsA signed encounter does not automatically mean a claim was created. Reconcile completed visits with entered charges and submitted claims to find services still waiting for billing.
Clearinghouse acceptance confirms a transmission step, not reimbursement. Payer acceptance, adjudication, and payment reconciliation need separate follow up.
An overall payment can conceal a denied line, an adjustment, or a possible underpayment. Review each line before treating the entire claim as settled.
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HHS identifies billing as a business associate activity when it involves PHI. Establish the required business associate agreement and clarify permitted uses, safeguards, and reporting obligations before information is exchanged.
Confirm individual user access, approved channels, and how permissions are updated when roles change. Establish an agreed process for sharing documentation, raising security questions, and handling information requests.
Agree on documentation responsibilities, incident escalation, and the practice’s oversight role. A vendor’s general compliance statement should lead to a specific discussion of safeguards and contractual responsibilities.
A new provider, group affiliation, or location may need an enrollment update.
Claims can stall if enrollment details and the billed service do not align. An application in progress is different from an approved effective date.
Check enrollment status, provider identifiers, service location, and payer requirements. Minnesota DHS directs providers and billing organizations to its MHCP enrollment process.
The coverage shown for a patient may require a different billing destination or plan workflow.
Using a familiar payer route without checking the member’s coverage can create rejections, delays, or unnecessary rework.
Verify the actual plan for the date of service, the correct billing route, and the plan’s authorization and submission rules.
An encounter may be complete while the billing record is missing a required detail.
The claim may remain unbilled or require additional records after submission. Repeated gaps increase the team’s administrative workload.
Reconcile completed encounters to charges, track documentation queries, and confirm authorization details before the claim leaves the practice.
Follow-up notes may show repeated status checks without a documented resolution plan.
Balances continue aging while filing or appeal deadlines approach. Staff may repeat work another team member already performed.
Assign the next action, owner, and due date. Separate claims awaiting payer action from those awaiting practice documentation or a billing correction.
Illustrative view
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Maximize Ophthalmology Revenue with 99% Clean Claim Accuracy
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They can include eligibility review, coding, charge entry, claim submission, payment posting, denials, A/R follow-up, and reporting. Credentialing may be a separate or related service. PROMBS works with practices to define the scope; confirm included tasks and retained responsibilities in the agreement.
Pricing depends on the practice and service scope. Ask whether fees are percentage-based, fixed, or per service, what collections are included in the fee calculation, and whether credentialing, historical A/R, software, or setup costs are separate. The calculator above uses illustrative rates, not a PROMBS quote.
Compatibility needs to be reviewed for your specific platform and workflow. Share the software name, clearinghouse, available access, reporting needs, and required integrations. Confirm supported tasks, permissions, and any additional costs before agreeing to an implementation plan.
Existing claims need an explicit handoff plan. Inventory open claims, denials, payer correspondence, pending records, and approaching deadlines. Agree on who handles historical A/R, which party receives late payments, and how work will be reconciled so balances remain assigned during the transition.
MHCP enrollment is a separate requirement from simply preparing a claim. Minnesota DHS states that providers and billing organizations doing business with MHCP must enroll. Review provider type, affiliations, locations, and effective dates, and confirm any managed care plan requirements that apply to your services.
Review the business associate agreement, permitted access, communication channels, and incident responsibilities before sharing protected health information. Ask for specific safeguards and contractual commitments rather than relying on a general compliance label. The practice should also define its oversight and documentation responsibilities.
Thousands of providers are growing their practice with PROMBS. Now it’s your turn.
Our billing specialists are ready to analyze your practice and show you exactly how much revenue you can recover.
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