Medical billing
Eligibility checks, charge capture, claim scrubbing, and submission — clean claims out fast, denials worked, payments posted and reconciled.
99% first-pass acceptance targetmedical billing services →4.9 on Google · Trusted by 500+ U.S. practices
RevalonMD — Specialty-Certified Medical Billing, Coding & Credentialing
Medical billing services convert a clinical encounter into a paid claim — verifying eligibility, coding the visit, scrubbing and submitting the claim, posting payment, and appealing denials. RevalonMD provides specialty-certified billing for U.S. practices at a 2.99% starting rate with a 99% first-pass claim target (RevalonMD metric).
Free audit
Get a free revenue-leakage audit
We review your denials, AR aging, credentialing gaps, and coding accuracy — then deliver a written findings summary with an estimated monthly recovery range. No PHI required to book.
Google4.9★Trustpilot4.8★BBBA+HIPAABAAevery clientAAPCAHIMAHFMA
99%
First-pass clean claims (target)
<30
Days in A/R
+30%
Revenue increase
96%
Collection ratio
24–48h
Claim submission
500+
Providers served
Services
What our medical billing services include
RevalonMD’s medical billing services cover the full revenue cycle: eligibility verification, charge capture, certified coding, claim scrubbing, electronic submission, payment posting, and denial follow-up — plus credentialing, prior authorization, and AR recovery. One accountable partner owns every step from the clinical encounter to the posted payment.
Most billing problems are fragmentation problems.
A practice outsources claims to one vendor, credentialing to another, and leaves denials to whoever has time on Friday. Each hand-off loses information, and each loss shows up later as a rejection, a denial, or a write-off.
RevalonMD removes the hand-offs.
The same team that verifies eligibility also scrubs the claim, posts the electronic remittance advice (ERA), and appeals the denial — so accountability never changes hands.
Eight service pillars make up that single revenue cycle. Each links below to its full service page, where scope, process, and pricing are documented in detail.
Medical coding
AAPC- and AHIMA-certified coders assign CPT 2026, ICD-10-CM FY2026, and HCPCS Level II codes with NCCI edits applied before submission.
CPT 2026 · ICD-10-CM FY2026 · NCCI editsmedical coding services →Medical credentialing
CAQH ProView, PECOS, and commercial payer enrollment managed end to end — typically 45–90 days, with re-attestation tracked every 120 days.
45–90 day typical turnaroundprovider credentialing →Revenue cycle management
Full ownership of the revenue cycle — from scheduling and eligibility through net collection rate reporting — under one accountable team.
Days in AR & NCR reported monthlyrevenue cycle management →Denial management
Every denial root-caused by CARC/RARC code, corrected, appealed, and fed back into front-end edits so the same denial stops recurring.
Every denial root-caused by CARC/RARCdenial management →Prior authorization
Authorizations initiated, documented, and tracked to payer decision windows — 72 hours expedited, 7 days standard under CMS-0057-F (2026).
72h expedited · 7-day standard (CMS-0057-F)prior authorization →AR recovery
Aged accounts receivable worked systematically by payer and aging bucket — recovered before timely-filing limits close, not written off.
120+ day buckets worked, not written offaccounts receivable recovery →Practice management consulting
Fee-schedule analysis, payer-mix strategy, and workflow design that lift collections per encounter — guided by your own claims data.
Fee-schedule & payer-mix analysispractice management consulting →Process
How the medical billing process works
A claim moves through seven steps: eligibility verification, charge capture, coding, claim scrubbing, submission, payment posting, and denial follow-up. RevalonMD runs every step in your existing EHR and clearinghouse, applying NCCI and payer edits before submission so the claim is paid the first time it is filed.
The grid above shows what we do; this is how the work actually flows. Each step exists to protect the one metric that decides whether you get paid on time — first-pass acceptance.
- Eligibility verificationCoverage and benefits confirmed before the visit, so claims start clean.
- Charge captureEvery billable service captured from the encounter — nothing leaks.
- CodingCertified coders assign CPT 2026 and ICD-10-CM FY2026 codes with modifiers.
- Claim scrubbingNCCI and payer edits applied before the claim ever leaves the building.
- SubmissionEDI 837 claims filed through the clearinghouse within payer timely-filing windows.
- Payment postingERA/EOB payments posted and reconciled against expected reimbursement.
- Denial follow-upDenials root-caused by CARC/RARC, corrected, appealed, and prevented.
Two distinctions matter here, because vendors blur them.
Billing≠Coding
Billing is not coding: coding assigns CPT 2026 and ICD-10-CM FY2026 codes to the encounter; billing turns those codes into a compliant CMS-1500 or EDI 837 claim and follows the money.
Rejection≠Denial
And a rejection is not a denial: a rejection never enters the payer’s system and can be corrected and refiled the same day, while a denial is an adjudicated refusal that needs a coded appeal.
RevalonMD works both — and reports them separately, because they have different root causes and different fixes.
Clean claims start before the visit.
Eligibility runs up front, charge capture reconciles the superbill against the schedule so no encounter goes unbilled, and the claim scrubber applies National Correct Coding Initiative (NCCI) edits, medical necessity checks, and payer-specific rules before anything leaves the building. That front-loading is the mechanism behind the first-pass numbers in the next section.
How it works
Live in 30 days, without disruption
Free auditWe review 90 days of your remits
Onboarding (48h)BAA signed, access set up
Credentialing & setupPayers, EHR & clearinghouse mapped
Claims liveClean claims out in 24–48 hours
Weekly reportsDashboard & payer scorecards
Performance
Why first-pass rate and days in AR matter
First-pass acceptance rate is the share of claims a payer accepts on first submission; days in accounts receivable (AR) measures how long revenue sits unpaid. MGMA benchmarks clean claims at 95% and first-pass resolution near 90% — RevalonMD targets 99% (RevalonMD metric, MGMA 2024–2025 context).
Process discipline only matters if it shows up in the numbers a practice owner actually feels — cash arriving sooner, less staff time burned on rework, and fewer dollars written off.
99%
First-pass claim acceptance target
RevalonMD metric; MGMA clean-claim benchmark is 95%, first-pass resolution ~90% (MGMA, 2024–2025).
2.99%
Starting billing rate, % of collections
RevalonMD published rate; outsourced billing runs 4–12% industry-wide (2026 pricing surveys).
45–90
Days, typical credentialing turnaround
Consistent with CMS PECOS enrollment timelines (CMS, 2026); payer- and CAQH-dependent.
500+
Provider clients, all 50 states
RevalonMD metric (founder-verified), across 50+ medical specialties.
Denials are rising+60% in 2024
The context behind those cards: claim denials rose roughly 60% in 2024 versus the prior year (MGMA Stat, 2024), which means every percentage point of first-pass acceptance is worth more than it used to be.
What one denial costsWeeks of delay
Each denied claim costs staff time to rework, delays payment by weeks, and risks the timely-filing window entirely.
90% vs 99%1 in 10 → 1 in 100
A practice running at the ~90% first-pass standard reworks one claim in ten; at 99%, it reworks one in a hundred. The difference compounds into net collection rate — the share of collectable revenue you actually collect.
These figures are RevalonMD’s own operating metrics, stated as targets and verified by the Founder before publication — not industry averages dressed up as guarantees. The benchmarks they are measured against come from MGMA’s published surveys (2024–2025) and CMS enrollment timelines (2026).
Coverage
50+ specialties, all 50 states
RevalonMD bills for more than 50 medical specialties across all 50 U.S. states, with specialty-certified coders assigned by field — cardiology, behavioral health, orthopedics, primary care, gastroenterology, and pediatrics among the deepest benches. State-specific payer rules, fee schedules, and filing windows are handled by the assigned team.
Metrics travel only if the team knows your specialty’s codes and your state’s payers. Specialty assignment is how the numbers above hold from a Texas cath lab to a New York therapy group.
Specialty billing fails on specifics: cardiology lives and dies on cath-lab bundling and evaluation-and-management (E/M) levels; behavioral health depends on time-based CPT codes and telehealth parity rules; orthopedics turns on global surgical periods and modifier accuracy. RevalonMD assigns coders certified in your field — AAPC and AHIMA credentials, audited monthly — rather than rotating generalists across every account.
- Cardiology
- Behavioral health
- Orthopedics
- Primary care
- Gastroenterology
- Pediatrics
- + 44 more specialties
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Payers & platforms
Payer scope — and EHR-agnostic by design
RevalonMD works claims for Medicare, Medicaid, UnitedHealthcare, Aetna, Cigna, Humana, BCBS plans, Tricare, and VA — and operates inside your existing EHR and clearinghouse, including Epic, athenahealth, eClinicalWorks, Tebra, AdvancedMD, Availity, and Waystar. No data migration, no new software for your staff.
Specialty knowledge sets the codes; payer knowledge gets them paid. Every payer below has its own edits, filing windows, and appeal rules — and your billing team should already know them.
Being EHR-agnostic is an operating decision, not a slogan. Your team keeps its workflows and its login screens; ours works inside them. Claims file as EDI 837 through your clearinghouse, remittances return as ERA/EOB and post against expected reimbursement, and eligibility runs through the same connections your front desk already uses. Switching billing partners should never mean switching systems.
MedicareMedicaidUnitedHealthcareAetnaCignaHumanaBCBS plansTricareVAEpicathenahealtheClinicalWorksTebraAdvancedMDAvailityWaystar
Worked example
A worked example: recovering a cardiology group’s AR
Benchmarks describe the average; an actual account shows the mechanism. This anonymized engagement is the pattern we see most often in multi-provider groups.
Anonymized client engagement · multi-provider cardiology
A 14-provider cardiology group came to RevalonMD carrying a heavy 120-plus-day AR bucket. Root-cause analysis traced the largest denial cluster to Claim Adjustment Reason Code (CARC) 16 — claims lacking required information — driven by incomplete prior-authorization documentation on cath-lab procedures.
The fix ran in two directions at once. Backward: corrected claims and coded appeals were filed against the open denials inside each payer’s appeal window. Forward: the missing documentation was added to the front-end scrubber rules, so new claims could not leave with the same defect. Aged AR came down as appeals paid, and the denial cluster stopped refilling — the first-pass rate recovered and held.
CARC 16root-cause denial code identified
120+ daysAR bucket worked down via appeals
2-way fixappeals backward, scrubber edits forward
Details anonymized; no client is named without written consent. Outcome is specific to this engagement, not a guarantee.
Results
Practices like yours, paid properly
+$840K
Recovered aged A/R the previous biller had written off, in the first two quarters.
14% → 3.8%
Denial rate cut by two-thirds in one quarter with root-cause fixes at the front desk.
21 days
Days in A/R dropped from 54 to 21 after eligibility automation and payer scorecards.
Testimonials
What practice owners say
“Our denial rate dropped from 14% to under 4% in one quarter. The monthly reporting alone is worth it.”
“They recovered aged A/R our previous biller had written off. The first two quarters paid for years of fees.”
“Credentialing with three new payers took six weeks, not six months. We finally trust our numbers.”
Pricing
Transparent pricing: starting at 2.99% of collections
RevalonMD’s billing rate starts at 2.99% of monthly collections — published here, not quoted behind a sales call. Outsourced billing runs 4–12% of collections industry-wide (2026 pricing surveys). There are no setup fees, no per-claim fees, and no termination fees; coding, scrubbing, and denial work are included.
The worked example above is what the fee actually buys: root-cause analysis, appeals, and prevention — priced as a percentage of what we collect, so our incentive is your collection rate.
2.99%starting rate · % of collections · no hidden fees
- Billing, certified coding & claim scrubbing
- Denial management & coded appeals
- Payment posting & ERA/EOB reconciliation
- AR follow-up within timely-filing windows
- Monthly days-in-AR & collection reporting
- Dedicated account manager
Book a free revenue-leakage auditSee what the 2.99% rate includes
Rate applies to standard billing engagements; final quote depends on specialty, claim volume, and service scope. Full terms on the pricing page.
Compliance
HIPAA, BAA, and how PHI is protected
RevalonMD operates as a HIPAA business associate under 45 CFR Parts 160 and 164 and signs a Business Associate Agreement (BAA) with every client before any protected health information (PHI) is exchanged. PHI is encrypted in transit and at rest, and is never collected through web forms or unsecured email.
Price means nothing if the partner handling your patients’ data is a compliance risk. Here is exactly where RevalonMD’s obligations come from and how they are met.
The HIPAA Privacy and Security Rules (45 CFR Parts 160 and 164, current 2026) define what a billing company may do with PHI and what safeguards it must maintain. The BAA is the contract that makes those obligations enforceable — which is why the Founder signs one with every client, without exception, before onboarding begins. Access is role-based, audit-logged, and limited to the minimum necessary standard. Security practices are documented in full on the HIPAA & BAA security practices page.
PHI protection stack45 CFR Parts 160 & 164
- Signed BAA firstBefore any PHI is exchanged
- EncryptionIn transit and at rest
- Role-based accessAudit-logged, every touch
- Minimum necessaryAccess limited to the standard
Comparison
Why RevalonMD vs. in-house billing or another vendor
In-house billing carries fixed overhead — salary, software, clearinghouse fees — regardless of how much is collected, and most billing vendors quote 4–12% of collections without publishing a rate. RevalonMD prices at a published 2.99% starting rate and is paid on collections, so the incentive is alignment, not activity.
Compliance is the floor, not the differentiator. The table below is the practical comparison a practice owner actually runs — current setup versus one accountable partner.
| Dimension | Typical in-house setup | RevalonMD |
|---|---|---|
| Cost | Salary, benefits, software, clearinghouse fees — fixed overhead regardless of collections | 2.99% of collections starting rate; you pay on what is actually collected |
| Coding credentials | Varies; certification and continuing education are the practice's burden | AAPC- and AHIMA-certified coders, audited for accuracy |
| First-pass performance | Practice-dependent; denial rework often absorbs staff time | 99% first-pass acceptance target (RevalonMD metric; MGMA benchmark 95% clean-claim) |
| Denial management | Worked when staff have time; root causes rarely tracked | Every denial root-caused by CARC/RARC, appealed, and prevented upstream |
| Credentialing | Often outsourced separately or handled ad hoc | CAQH, PECOS, and payer enrollment managed in-house, typically 45–90 days |
| Coverage continuity | Vacations, turnover, and training gaps stall the cycle | Team coverage across all 50 states — the cycle never waits on one person |
| Compliance | HIPAA training and BAA chains are the practice's responsibility | HIPAA-compliant under 45 CFR Parts 160/164; signed BAA with every client |
| Reporting | Whatever the PM system exports | Days in AR, net collection rate, and denial trends reported monthly |
In-house billing vs. RevalonMD, dimension by dimension. Sources: MGMA 2024–2025 benchmarks; CMS 2026 enrollment timelines; 2026 industry pricing surveys.
FAQ
Frequently asked questions
Medical billing services convert a clinical encounter into a paid claim — verifying eligibility, coding the visit, scrubbing and submitting the claim, posting payment, and appealing denials. RevalonMD delivers this end to end for U.S. practices across 50+ specialties.
Outsourced billing typically costs 4–12% of collections industry-wide (2026 pricing surveys). RevalonMD starts at 2.99% of collections — among the lowest in class — with no hidden setup or termination fees. See /pricing/ for what's included.
First-pass rate is the share of claims a payer accepts on first submission. MGMA's clean-claim benchmark is 95% and the first-pass resolution standard is ~90% (MGMA, 2025). RevalonMD targets a 99% first-pass rate (RevalonMD metric).
Yes. RevalonMD is HIPAA-compliant under 45 CFR Parts 160 and 164 and signs a Business Associate Agreement with every client before any PHI is exchanged. PHI is encrypted in transit and at rest and never collected via web form.
RevalonMD is EHR-agnostic and integrates with all major EHR and practice-management platforms — including Epic, athenahealth, eClinicalWorks, and Tebra — serving 50+ medical specialties across all 50 U.S. states.
Yes. Beyond billing, RevalonMD provides medical coding, provider credentialing, denial management, prior authorization, AR recovery, revenue cycle management, and practice-management consulting — the full revenue cycle from one accountable partner.
Provider credentialing typically takes 45–90 days, depending on payer and CAQH-profile completeness. Medicare enrollment via PECOS often clears in 45–60 days with complete documentation (CMS, 2026). RevalonMD manages CAQH, PECOS, and payer enrollment end to end.
Book a free revenue-leakage audit: RevalonMD reviews your denials, AR aging, credentialing gaps, and coding accuracy, then delivers a written findings summary and an estimated monthly recovery range. No PHI is required to book.
Explore
Explore our services
Every pillar below goes deeper than this page can: scope, process, pricing, and specialty detail, each reviewed by the credentialed owner of that silo.
Who stands behind this page
Methodology: performance figures on this page are RevalonMD operating metrics, reviewed quarterly and signed off by the Founder before publication. Industry benchmarks and regulatory timelines are cited inline from primary sources. Medical code references name their code year (CPT 2026; ICD-10-CM FY2026) and are verified by the Coding Director before publish.
MGMA benchmarking, 2024–2025CMS PECOS enrollment, 2026CMS-0057-F (PA Final Rule), eff. 202645 CFR Parts 160 & 164 (HIPAA)AMA CPT 2026CMS ICD-10-CM FY2026CAQH ProView · NUCC, 2026
Find out what your practice is leaving on the table.
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