Nexus io provides physician billing services to help medical practices get paid faster and face fewer claim rejections. Our AAPC-certified billing professionals and cloud-based technology work in combination to improve coding accuracy, simplify claims submission, and reduce administrative workload.
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Medical billing directly affects the financial viability of your physician practice. Even little mistakes can interrupt your entire business revenue cycle. Frequent claim denials, incorrect CPT or ICD-11 code assignment, and reimbursement delays all place a strain on your cash flow. The nationwide shortage of qualified medical coders makes it more difficult than ever to maintain consistent expertise in-house.
Nexus io addresses these issues with end-to-end physician medical billing optimized for accuracy, compliance, and efficiency. Our AAPC-certified billing specialists maintain high coding accuracy rates, resulting in clean claims and fewer costly denials.
Optimized charge capture, clinical documentation integrity support, and real-time quality control help you manage your healthcare revenue cycle and increase cash flow. Nexus io serves 55+ specialties, including cardiology, orthopedics, internal medicine, and dermatology. Our physician billing system grows with your business and accommodates any clinical specialty you offer.
Physician practices bill across multiple payer contracts using different rules for E/M leveling, modifier use, and diagnosis sequencing. One discrepancy between documentation and coding results in a denial, which delays payment for weeks and creates a large amount of rework for staff.
As the number of providers increases, the likelihood of more claims being generated, as well as the chances of errors also increases. Detecting problems before submission of a claim will result in quicker A/R cycles and more predictable revenues than if they were found only after the claims were denied.
E/M coding is one of the most common errors made in physician billing. A provider may document a very complex visit but select an incorrect (less) level of service when billing for that visit. Another frequent area of error in physician billing is with modifiers. If a CPT code is billed with an incorrect ICD-10 code, the claim will be denied as not medically necessary.
A few other areas of concern include duplicate charges, missed eligibility checks, and being billed on outdated fee schedules; all of these will delay your revenue cycle and add to your staff’s workload.
We reduce errors through careful alignment of clinical documentation, diagnosis codes, and procedure codes. Each encounter is reviewed for proper E/M leveling, correct modifier application, and accurate ICD-10-CM sequencing. CPT codes are matched to documented services; nothing is assumed or missed.
Claims are submitted only after eligibility verification and payer-specific edit checks. Our team monitors timely filing the claims across commercial insurance plans, Medicare, and Medicaid to prevent preventable write-offs. Denied claims get immediate attention. We identify root causes, correct errors, and resubmit or appeal based on payer requirements.
Start improving revenue outcomes with a partner experienced in physician medical billing, credentialing, and provider enrollment, and A/R recovery. We help practices navigate complex payer requirements, maintain compliance with CMS and HIPAA standards, and reduce administrative strain on your staff.
To explore how our medical billing services for physicians can support your practice, submit a brief inquiry. One of our billing specialists will respond within 12 hours.
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We manage multiple payer contracts with very different requirements regarding fee schedules, documentation, authorizations, and many more. Payer rules change frequently without notice. Providers handle an average of 39 prior authorization requests per week. This easily takes up nearly two business days of staff time on paperwork alone. These loopholes present an opportunity for errors when it comes to payment for services rendered.
As a physician billing company, our role is to ensure that each physician’s billing services adhere to each payer’s guidelines and to verify eligibility prior to the delivery of medical services. In addition to providing structured oversight, we work to keep your billing compliant with the technical and clinical guidelines established by each payer.
Physician billing denials occur for various reasons, most commonly due to a mismatch between CPT/ICD-11 codes, missing documentation, modifier errors, or eligibility issues. Our team addresses these issues prior to submission to the payer.
Each encounter (office visits, diagnostic tests, and procedures) is reviewed against the documentation needed by the payer. We track denial patterns across your payer mix, identify emerging trends, and manage follow-up to support consistent reimbursement and strengthen your revenue cycle.
Medicare’s Merit-based Incentive Payment System (MIPS) now enforces a 75 point performance threshold. Failing to meet this benchmark can result in up to a 9% reimbursement penalty, while exceeding it can significantly boost your revenue making MIPS reporting a critical part of your practice’s financial strategy.
As a physician billing and MIPS support partner, Nexus io helps providers optimize MIPS category performance through accurate coding, real-time quality reporting, and proactive denial reduction. Our team ensures full compliance with CMS MIPS requirements, enabling you to avoid negative payment adjustments, earn incentive bonuses, and protect your revenue cycle.
Physician practices operate on demanding schedules, and billing questions don’t wait for business hours. Our team is available 24/7 to help with prior authorization challenges, E/M coding questions, modifier disputes, payer-specific paperwork needs, and claim submission concerns.
Our support services cover every part of the revenue cycle, including denial management, A/R follow-up, eligibility verification, credentialing, and provider enrollment. Each service addresses the clinical and administrative requirements of private practices, group practices, and multi-specialty clinics.
Our achievements are a testament to our hard work team to deliver exceptional revenue boost results and gain the client’s trust in us.
What is a good claim denial rate for a physician practice?
An optimal denial rate for an industry benchmark falls between 5%-10%. If the practice has a denial rate less than 5%, then that indicates good overall performance of the practice’s revenue cycle. If a practice has a denial rate greater than 10%, it is likely losing considerable revenue due to preventable errors. Reliable medical billing services for physicians focus on keeping denial rates well below industry average through pre-submission claim scrubbing and payer-specific edit checks.
Can I switch billing companies without disrupting my cash flow?
Yes, a structured transition plan is designed to eliminate any possibility of a revenue interruption from the transition between medical billing companies. A physician medical billing company, such as Nexus io, can provide the physician with the proper means to migrate all data from their previous medical billing company, set up their payers and provide connections to clearinghouses prior to going live with the new billing company.
What is the difference between in-house billing and outsourced billing?
With in-house billing, a business must either hire employees, purchase software, and manage its own training and compliance, or all of this is handled by a physician medical billing services provider. It will submit claims to payers, manage follow-up processes, and handle denial management. Most offices that utilize outsourced billing improve their overhead costs and collection rates.
How long does it take to see results after switching billing companies?
Most offices see quantifiable improvements in their billing process within 60 – 90 days after implementing an outsourcing solution. The initial measurable improvement is seen as the number of clean claims submitted increases, followed by a decrease in the time to collect on accounts receivable (A/R) and higher net collections. It typically takes 3-6 months to fully optimize the entire revenue cycle from the time a new billing partner is put in place, based on the number of payers and the complexity of the payer types.
Optimizing reimbursement in physician practices demands disciplined workflows, accurate documentation, and payer-aligned processes. We create structured physician revenue cycle management; our team helps practices stabilize cash flow and improve operational performance. Complete the short form, and one of our experts will connect with you within 12 hours.
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