Medical Billing Services

Medical billing is the work between the visit and the deposit: confirming coverage, coding the encounter, getting a clean claim to the right payer, posting what comes back, and chasing what does not. When it slips, the cost shows up months later as denials nobody worked and balances past the filing limit. Maximum Billing, LLC provides medical billing services for physician practices, clinics, and specialty groups in twelve states, working inside the practice management system you already use.

Schedule a consultation or call 800-820-0364.

What Our Medical Billing Services Include

Our medical billing covers the full revenue cycle, from the day an appointment is booked to the day the last dollar is collected:

• Before the visit: coverage, benefits, and prior authorization checks, so problems are found while the patient can still be told.
• After the visit: charges entered and coding checked against the note, then claims scrubbed and sent to the right payer. Our guide to the claim submission process walks through each step.
• When payment arrives: remittances posted line by line and compared with your contracted rates, so a short payment is caught rather than accepted.
• When it does not: rejections fixed and resent, denials grouped by cause and appealed, and every open claim followed until it is paid or resolved.
• The patient side: statements and answers to balance questions, handled in a way that protects your relationship with the patient.
• The enrollment side: credentialing for new clinicians, locations, and payers, which keeps claims from denying before they are even read.

Practices decide how much to hand over. Ours range from full revenue cycle clients to practices that only need their denials and aging claims worked.

Medicare, Medicaid, and Commercial Plans

Most practices bill a mix of payers, and each one has its own rules.

• Medicare. Original Medicare claims go to the Medicare Administrative Contractor for your region, and Medicare enrollment is managed through PECOS, with revalidation required on a regular cycle. Medicare Advantage plans are run by private insurers with their own networks, authorization rules, and fee schedules, so a patient with a Medicare card may not be billed to Medicare at all.
• Medicaid. Every state runs its own Medicaid program, and most enroll members in managed care plans that each require separate credentialing. Our state Medicaid provider enrollment guides cover the enrollment process state by state.
• Commercial plans. Payer policies on authorizations, modifiers, telehealth, and timely filing differ from plan to plan and change during the year, which is why we track them by payer rather than treating every claim the same.

Coding That Holds Up

A claim is only as good as the coding and documentation behind it. We review the details that most often decide whether a claim pays the first time:

• Evaluation and management levels. Office and outpatient visits are selected on medical decision-making or total time on the date of service, and the note has to support the level billed.
• Modifiers. Modifiers such as 25 for a separate E/M service on the same day as a procedure, and 59 for distinct procedural services, are among the most common reasons claims are denied or reduced when they are missing or misused.
• Diagnosis codes. ICD-10 codes have to support medical necessity for the service billed.
• Telehealth. Payers differ on place of service codes and modifiers for telehealth visits, so we check each payer’s current policy.

Where Medical Claims Lose Money

• Eligibility or authorization problems that were not caught before the visit.
• Claims rejected by the clearinghouse and never resubmitted.
• Denials written off instead of corrected and appealed.
• Short payments accepted because no one checked them against the contract.
• Claims that sat unworked until they passed the payer’s filing limit.
• Credentialing gaps that make a clinician’s claims deny as out of network.

Our claims denial management and accounts receivable management services explain how we work each of these.

Medical Billing by State

We bill for practices in Colorado, Connecticut, Florida, Georgia, Illinois, Missouri, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, and Texas. Each state has its own Medicaid program, prompt pay rules, and payer landscape. For a state-specific look, see our pages for Florida medical billing, Texas medical billing, New Jersey medical billing, New York medical billing, Pennsylvania medical billing, and Illinois medical billing. The Florida, Texas, and New Jersey pages also list the specialties we bill for.

Practices We Work With

• Small and solo practices that need a billing department without hiring one. See medical billing services for small practices.
• Physician groups and specialty practices with a mix of Medicare, Medicaid, and commercial payers. See group practice billing services.
• Dermatology practices, where same-day visits and procedures, lesion counts, and pathology-dependent excision codes decide payment. See dermatology billing services.
• Psychiatric practices, where medication management visits combine E/M coding with psychotherapy add-on codes. See psychiatric billing services.
• Practices that bill out of network for some or all plans. See out-of-network billing services.

We also bill for dental practices, mental and behavioral health practices, and therapy practices.

Credentialing and Enrollment

A clinician who is not enrolled correctly with a payer cannot be paid, no matter how clean the claim is. We handle CAQH profiles, Medicare enrollment, state Medicaid enrollment, and commercial plan applications, and we track revalidation dates so enrollment does not lapse. See our medical credentialing services.

The Numbers We Watch

As of 2026, our clients’ claims reach a 91% clean claim rate, and their accounts receivable average 34 days. The clean claim rate measures how many claims are accepted the first time they are submitted. Days in A/R measures how long, on average, it takes to collect what a practice has billed. You should be able to see both, along with aging by bucket and collections compared with what you are contractually owed.

How Getting Started Works

1. A conversation first. We learn your specialty, payer mix, software, and where money is getting stuck today.
2. A look at the numbers. Your aging report and recent denials show us what can still be collected and what keeps going wrong.
3. A signed Business Associate Agreement before any patient information changes hands.
4. System access. Logins to your practice management system, clearinghouse, and payer portals.
5. The handoff. New claims move to us right away, and older claims are worked in order of how close they are to their filing limits.
6. An enrollment check. We confirm each clinician’s enrollment with each payer, because a credentialing gap can look like a coding problem.

About Maximum Billing

Gina Abrotsky-Salvatore, CPCS, MHT, started Maximum Billing, LLC in 2018 after more than 20 years in insurance billing and revenue cycle management. The company is based in Fort Myers, Florida, and its certified billing and coding specialists work remotely for practices across our twelve states. Each team member completes HIPAA certification, and our HIPAA compliant billing services page describes how patient information is protected.

Frequently Asked Questions

Do we have to change our practice management software?

No. We work inside the system you already use, so your clinical workflow and patient records stay where they are.

Do you bill Medicare and Medicare Advantage?

Yes. We bill Original Medicare through the regional contractor and Medicare Advantage plans through each plan’s own process.

Can you work our old accounts receivable?

Yes. We review your aging report and work the balances that are still collectible, starting with claims closest to their filing limits.

Do you only bill for medical practices?

No. We also bill for dental, behavioral health, therapy, and psychiatric practices.

Talk to Us About Your Practice

Tell us about your specialty, payers, and software, and we will review your aging report and recent denials with you. Contact us to schedule a consultation, or call 800-820-0364.