Specialty-certified medical billing — eligibility through payment posting — for U.S. healthcare providers, with AAPC- and AHIMA-certified coders, a 2.99% starting rate, and a signed BAA with every client.
Medical billing is the end-to-end process of submitting and following up on insurance claims so healthcare providers receive payment for services rendered. It covers charge entry, coding, claim submission, denial management, and payment posting — the complete revenue cycle from the moment a patient is seen to the moment the provider is paid.
The 99% first-pass and 2.99% figures are RevalonMD targets and starting rates — RevalonMD internal performance target, not an industry average — based on client outcomes where claims are submitted with complete, accurate demographic and clinical data; individual results vary by payer mix and specialty.
Our AAPC- and AHIMA-certified team reviews a sample of your claims, flags denial drivers, and returns a written first-pass and days-in-AR assessment. No PHI required to book.
Benchmarks: HFMA top-performer first-pass 98%, national median ~85% (HFMA, 2026); industry average rate 5.8% with a 4–10% range (Neolytix 2026; NW MedBill 2026). RevalonMD performance figures are internal targets and starting rates, stated as targets — not guarantees — and are founder-sign-off pending.
Medical billing is the end-to-end process of submitting and following up on insurance claims so a healthcare provider is paid for services rendered. It spans front-end work — eligibility verification, prior authorization, and charge capture — and back-end work — coding, claim submission via EDI 837, denial management, and payment posting via ERA (EDI 835).
That definition sets the border for everything below. Medical billing is one phase of revenue cycle management — the work that turns a documented encounter into collected revenue. It splits cleanly into a front end and a back end.
Everything before the claim leaves the office: insurance eligibility verification (the 270/271 EDI transaction), prior authorization, demographic capture, and charge capture from the encounter. Errors caught here — a wrong member ID, a missing authorization — are denials that never happen.
Everything after the encounter is documented: medical coding, claim scrubbing, submission to the clearinghouse, payer follow-up, denial management, and payment posting. Back-end accuracy determines how much of the billed amount the practice actually collects.
Two standardized claim forms carry nearly every claim. The form depends on who rendered the service, and the version matters — RevalonMD verifies the current form version before submission.
| Form | Used for | Version note |
|---|---|---|
| CMS-1500 (02/12) | Professional / physician claims — outpatient and office services. | Maintained by the NUCC; the 02/12 version is current. Code-year/version verified by the Coding Director. |
| UB-04 (CMS-1450) | Institutional / facility claims — hospitals, surgical centers, and facility services. | Maintained by the NUBC. RevalonMD's pillar focus is professional billing; facility coding is scoped per engagement. |
CMS-1500 is stewarded by the NUCC; UB-04 (CMS-1450) by the NUBC. Form versions are verified by the Coding Director before use in client claims.
A billing operation is judged on a handful of metrics. Here is how RevalonMD’s targets sit against the MGMA and HFMA benchmarks and the national average — the comparison most billing pages never publish.
| KPI | RevalonMD target ★ | MGMA / HFMA benchmark | National average |
|---|---|---|---|
| First-pass claim rate | 99% ★ | HFMA top-performer 98% | ~85% median |
| Clean claim rate | 99% ★ | HFMA 95–98% | — |
| Days in A/R | ≤35 days ★ | MGMA ≤35 days | 40–52 days |
| Net collection rate | ≥95% ★ | Top-performer 95% | ~85% median |
| Denial rate | <3% ★ | MGMA ≤8% | 10%+ |
| A/R over 90 days | <10% ★ | MGMA ~13.5% | — |
Sources: MGMA billing benchmarks (2026); HFMA clean-claim benchmark (2026). ★ RevalonMD figures are internal targets with stated assumptions; they are not guarantees of practice-specific results.
Every error caught before submission is a denial that never happens.RevalonMD’s certified team verifies eligibility, codes to current code years, and scrubs every claim before it reaches a payer. Book a free billing audit →
Providers outsource medical billing when in-house billing costs exceed the outsourced rate, when staff turnover disrupts cash flow, or when denial rates climb above the MGMA 8% benchmark. An outsourced billing company brings specialty coding expertise, dedicated denial management, and no staffing overhead — converting a fixed payroll cost into a percentage of collections.
Outsourcing is a revenue decision, not just a cost decision. Three forces push practices off in-house billing — and one checklist separates a real partner from a vendor.
A single biller's fully loaded cost — salary, benefits, billing software, and clearinghouse fees — runs well beyond the headline salary, and one departure can stall cash flow for weeks. Denial rework adds $25–$117 per reworked claim in administrative time (industry-cited, 2024–2026). Outsourcing converts that fixed overhead into a percentage of what is actually collected.
The outsourced segment held 54.3% of the medical billing market in 2026 as practices shifted from cost-cutting to revenue performance (Coherent Market Insights, 2026). AI-assisted claim scrubbing, the CY2026 Medicare Physician Fee Schedule changes (CMS-1832-F, effective Jan 1, 2026), and rising prior-authorization burden all favor a specialized partner over a one- or two-person in-house team.
Require a stated starting rate, a published first-pass or clean-claim benchmark with its assumptions, AAPC- and AHIMA-credentialed coders, a signed BAA before any PHI is shared, and transparent monthly KPI reporting. A partner that will not commit any of these in writing is shifting risk back onto the practice.
Market context: the outsourced segment held 54.3% of the medical billing market in 2026 as buyers shifted from cost to revenue performance (Coherent Market Insights, 2026). The CY2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F) took effect January 1, 2026.
RevalonMD targets a 99% first-pass claim rate against the HFMA top-performer benchmark of 98% and a national median near 85%. Every account is staffed by coders holding both AAPC (CPC) and AHIMA (RHIA/CCS) credentials — dual-body certification no top-10 competitor publishes — and a Business Associate Agreement is signed before any PHI is exchanged.
A published rate, a benchmarked first-pass target, dual certification, and a BAA with every client — here is what RevalonMD commits to on every account.
A published floor rate — roughly 48% below the 5.8% industry average and under the 4–10% range most companies charge (Neolytix 2026; NW MedBill 2026). No competitor on the top-10 SERP states a starting rate on its billing pillar.
A target measured against the HFMA top-performer benchmark of 98% and a national median near 85% (HFMA, 2026). Stated as an internal target with its assumptions — not an industry average presented as a guarantee.
RevalonMD staff hold both AAPC (CPC) and AHIMA (RHIA/CCS) credentials, covering professional and facility coding in one team. No competitor on the top-10 SERP claims dual-body certification.
A HIPAA Business Associate Agreement under 45 CFR §164.504(e) is executed before any PHI is exchanged — zero exceptions. Most competitors list a BAA as optional or on request.
Credentialing integrated with billing, targeting 45–90 days for CAQH-complete providers versus a 90–150+ day industry norm — closing the revenue gap that standalone billing companies leave open.
Specialty-certified coding across 50+ medical specialties with no geographic restriction — state-specific Medicaid and payer rules are built into the workflow.
One multi-provider orthopedic group transitioned to RevalonMD while operating below its target clean-claim rate with days-in-AR well above the MGMA ≤35-day benchmark. RevalonMD rebuilt the front-end eligibility and coding workflow, and the group moved toward the first-pass and AR benchmarks over the following quarter — with no interruption to billing during the transition.
Anonymized engagement. Results represent one client’s experience and are not a guarantee of future outcomes; specific figures are founder- and client-verified before publication (brief SVC-9).
RevalonMD's medical billing process runs seven steps: patient access and insurance eligibility verification, charge capture and superbill review, medical coding (CPT 2026, ICD-10-CM FY2026, HCPCS 2026), claim scrubbing and EDI 837 submission, payer follow-up and denial management, payment posting and ERA/EOB reconciliation (EDI 835), and patient statements, collections, and KPI reporting.
The seven steps are sequential and compliance-gated: nothing touches a chart before the BAA is signed, and every claim is scrubbed against payer edits before it leaves the clearinghouse.
Claims move on the standard EDI transaction set — eligibility on 270/271, claims on EDI 837, remittance on EDI 835 (ERA) — and are coded from CPT 2026, ICD-10-CM FY2026, and HCPCS Level II 2026 ⚑, validated against current NCCI edits (CMS). Code-year references are verified by the Coding Director at each refresh.
Specialty-specific medical billing matters because code sets, modifiers, and payer rules change by specialty. A cardiology claim follows different bundling and medical-necessity rules than an orthopedic post-operative visit. RevalonMD bills across 50+ medical specialties with coders trained by specialty cluster, so laterality, global periods, and NCCI edits are applied correctly on the first submission.
A code is only correct in context. Each specialty below links to its dedicated billing page as the children launch; the pillar carries the cross-specialty coding discipline.
Catheterization, device, and diagnostic coding with high-complexity bundling rules.
Global surgical periods, modifier 50/59 laterality, and DME interplay.
Time-based psychotherapy codes, telehealth parity, and payer authorization rules.
E/M leveling, chronic-care management, and preventive-visit coding.
Wide code range across ages with preventive and problem-visit bundling.
EEG/EMG diagnostics, infusion coding, and prior-authorization-heavy services.
Drug administration (J-codes), infusion hierarchies, and high-cost authorization.
Technical/professional component splits and modifier 26/TC accuracy.
S-codes, high volume, and place-of-service precision.
Lesion destruction/excision sizing, pathology coordination, and modifier 25.
Specialty coding accuracy is where billing and medical coding meet. Cross-silo, billing also connects to denial management (which works the denials that front-end accuracy prevents) and prior authorization (which stops authorization-related denials before the claim).
RevalonMD starts at 2.99% of net collections — roughly 48% below the 5.8% industry average and well under the 4–10% range most billing companies charge (Neolytix 2026; NW MedBill 2026). The starting rate includes eligibility verification, charge entry, coding, claim submission, denial management, payment posting, patient billing, and monthly reporting, with no setup or hidden fees.
RevalonMD starts at 2.99% of collections — 48% below the 5.8% industry average — with no setup fees and no hidden surcharges. The percentage model aligns incentives: RevalonMD is paid out of recovered revenue.
| Pricing reference | Rate |
|---|---|
| RevalonMD starting rate ★ | 2.99% of net collections |
| Industry average (2026) | 5.8% of monthly collections (Neolytix 2026) |
| Industry range (2026) | 4–10% of net collections (NW MedBill 2026; AMS Solutions 2026) |
| High-complexity specialties | 10–12% industry rate — cardiology, oncology, orthopedics (Neolytix 2026) |
| Per-claim alternative (industry) | $3–$10 per submitted claim — RevalonMD uses a % model |
| Hidden-fee warning (industry) | Setup, credentialing, and collections can add 15–30% elsewhere (Neolytix 2026) |
| RevalonMD fee commitment ★ | No setup fees, no data-conversion fees, no hidden surcharges |
Industry figures: Neolytix 2026 pricing guide; NW MedBill 2026. ★ RevalonMD rate and fee commitment are founder-sign-off pending. Starting rate for qualifying practices; the final rate is determined by specialty, claim volume, and service scope.
Move the slider to your monthly collections to see an illustrative in-house cost against the 2.99% rate. Estimate only — not a quote.
Every outsourced billing vendor that touches PHI is a HIPAA business associate and must sign a Business Associate Agreement (BAA) under 45 CFR §164.504(e) before any protected health information is exchanged. RevalonMD signs a BAA with every client covering all nine required elements — permitted uses, safeguards, breach notification, subcontractor flow-down, and termination among them.
Accurate claims mean nothing if the partner handling your PHI is a compliance risk. Here is where RevalonMD’s obligations come from, what the 2026 update changed, and the exact BAA elements to require from any billing partner.
Every outsourced billing vendor that accesses PHI is a HIPAA business associate. RevalonMD signs a Business Associate Agreement (BAA) under 45 CFR §164.504(e) with every client before any PHI is exchanged. The HHS Office for Civil Rights enforces HIPAA with civil penalties currently ranging from $141 to $2,134,831 per violation by tier (HIPAA Journal, 2026). A 2026 proposed HIPAA Security Rule update adds administrative and verification requirements for covered entities and their business associates — RevalonMD tracks the rulemaking and updates its safeguards as the rule is finalized.
Use this as a portable, audit-ready checklist for any billing partner. A compliant BAA must:
Source: HHS — Business Associate Contracts, 45 CFR §164.504(e); regulatory text in the Federal Register.
Provider credentialing is the enrollment that lets a provider bill a payer at all — and delays create a revenue gap most billing companies ignore. RevalonMD targets a 45–90 day credentialing turnaround for CAQH-complete providers versus a 90–150+ day industry norm, closing the window during which a credentialed provider would otherwise go unpaid.
Billing and credentialing are two halves of getting paid: one submits the claim, the other earns the right to submit it. RevalonMD runs both, so a new provider is not left unbillable.
A provider cannot bill a payer until enrollment is complete. At a 90–150+ day industry norm, a new or relocating provider can sit unbillable for months. A provider credentialed in 45 days instead of 120 recovers roughly 75 days of billable revenue — the exact dollar value depends on average daily collections and is confirmed per practice before any figure is published.
RevalonMD targets 45–90 days for CAQH-complete providers applying to cooperative payers, managing CAQH ProView setup and attestation as part of the workflow. Complex panels and government programs may take longer; the target carries a founder-sign-off assumption label until signed.
Provider enrollment and payer enrollment across Medicare, Medicaid (all 50 states), and major commercial payers — BCBS, Aetna, Cigna, UnitedHealth, and Humana among them — available standalone or bundled with medical billing. Covered-payer lists are confirmed with operations per engagement.
Credentialing is a service relationship of its own — explore provider credentialing and how it pairs with billing to close the revenue gap.
Medical billing is the end-to-end process of submitting and following up on insurance claims so healthcare providers receive payment for services rendered. It covers charge entry, coding (CPT 2026, ICD-10-CM FY2026), claim submission via EDI 837, denial management, and payment posting via ERA (EDI 835).
RevalonMD starts at 2.99% of net collections — the final rate depends on specialty, claim volume, and service scope. The industry average is 5.8% (Neolytix 2026). There are no setup fees or hidden surcharges.
A first-pass claim rate measures the percentage of claims paid in full on the first submission with no denial or rejection. The HFMA top-performer benchmark is 98%. RevalonMD targets 99%. Higher first-pass rates reduce denial rework costs and accelerate cash flow.
Outsourcing makes financial sense for most practices when in-house billing costs exceed the outsourced service rate, when staffing turnover disrupts cash flow, or when denial rates exceed 8% (the MGMA benchmark). Outsourced billing companies bring specialty coding expertise, dedicated denial management, and no staffing overhead.
RevalonMD signs a HIPAA-compliant Business Associate Agreement (BAA) with every client before any protected health information is exchanged, as required by 45 CFR §164.504(e). The BAA covers all nine required elements including permitted PHI uses, safeguard requirements, breach notification, and termination provisions.
RevalonMD provides specialty-certified billing across 50+ medical specialties including cardiology, orthopedics, mental and behavioral health, internal medicine, family practice, neurology, oncology, radiology, urgent care, and dermatology, among others.
Most practices complete the transition in 2–4 weeks. RevalonMD manages data migration, payer enrollment verification, and EHR integration. Billing continues without interruption during the transition period.
Yes. RevalonMD offers provider credentialing and payer enrollment with a 45–90 day turnaround target for CAQH-complete providers, compared to an industry average of 90–150+ days. Credentialing is available as a standalone service or bundled with medical billing.
Tell us about your practice and we’ll review a claim sample, identify denial drivers, and return a written first-pass and days-in-AR assessment. No PHI required — practice profile only.
Methodology: every quantitative claim on this page cites a dated source (CMS CY2026 MPFS; MGMA 2026; HFMA 2026; Neolytix 2026; NW MedBill 2026; HHS 45 CFR §164.504(e); HIPAA Journal 2026). Medical-code references name their code year (CPT 2026; ICD-10-CM FY2026; HCPCS Level II 2026) and are verified by the Coding Director before publication and re-verified each January when CMS and AMA publish updates. RevalonMD performance figures (99% first-pass, 2.99% starting rate, 45–90 day credentialing, 50+ specialties, BAA with every client) are internal operating targets and starting rates, founder-sign-off-gated, and stated as targets — not industry averages presented as guarantees.
Our AAPC- and AHIMA-certified team reviews a sample of your claims, identifies denial drivers, and returns a written assessment. RevalonMD signs a BAA before accessing any PHI; no PHI is required to book.