Primary Care revenue cycle management
At primary-care volume, the money leaks in coding - E/M levels, preventive-plus-problem, AWV/CCM/RPM and risk-adjustment gaps. AI agents catch it before the claim goes out, across the whole cycle.
Primary care wins on volume, prevention and chronic-care management - which is exactly where revenue slips away. AI agents support E/M and preventive-plus-problem coding, capture AWV, CCM and RPM, and flag open HCC and risk-adjustment gaps before the visit closes - then run eligibility, claims, posting, denials and collections behind it.
Coding & documentation
- E/M & preventive-plus-problem coding - Supports E/M level selection and preventive-plus-problem visits with modifier 25.
- AWV, CCM & RPM capture - Captures annual-wellness, chronic-care-management and remote-monitoring codes you're leaving behind.
- HCC / risk-adjustment gap flagging - Flags open HCC and risk-adjustment gaps before the visit closes.
- ICD-10 specificity prompts - Prompts for the specific diagnosis codes chronic conditions require.
- Transitional Care Management capture - Catches billable TCM after a hospital discharge.
- Immunization & admin code capture - Captures vaccine product and administration codes so none are dropped.
Eligibility & benefits
- Real-time verification at scale - Verifies eligibility for every visit and distinguishes preventive vs. problem coverage.
- Coverage discovery for self-pay - Finds active coverage for patients who present as self-pay.
- Secondary coverage / COB detection - Detects secondary and tertiary plans and coordinates benefits.
Prior authorization & referrals
- Medication prior authorization - Assembles and submits medication PAs with clinical justification.
- Imaging & specialist referral auth - Requests referral authorizations and routes them to the right specialist.
- Referral loop tracking - Tracks outbound referrals to close the loop and recapture the patient.
Claims & submission
- Claim scrubbing & NCCI edits - Scrubs claims against payer and bundling edits before submission.
- Claim status follow-up - Polls 276/277 status and chases stuck claims.
Payments, denials & AR
- ERA auto-posting - Posts 835 remittances and contractual adjustments automatically.
- Denial classification & auto-appeals - Classifies denials and drafts appeals for preventive-vs-problem and medical-necessity.
- AR worklist prioritization - Prioritizes the AR worklist by recoverable dollars and timely-filing risk.
Patient engagement & collections
- Preventive & chronic recall - Drives annual-wellness and chronic-care recall automatically.
- Point-of-service estimates & collection - Estimates patient responsibility and collects at the desk.
- Statements & payment plans - Sends statements, reminders and self-service payment plans.
Front office
- High-volume call answering & booking - Absorbs call volume and books preventive and chronic-care visits.
- Digital intake & insurance-card capture - Collects demographics and captures/reads the insurance card up front.
Analytics
- Panel & quality-gap dashboards - Surfaces open care gaps and value-based quality measures.
What you get
- Split preventive-plus-problem visits so both get paid
- Capture AWV, CCM and RPM revenue you're leaving behind
- Close HCC and risk-adjustment gaps before the visit ends
- Verify eligibility for every visit, at scale
- Automate medication and referral prior auths
- Recover preventive-vs-problem denials
Frequently asked questions
When do you use modifier 25 in primary care?
Modifier 25 is used when a significant, separately identifiable E/M service is performed on the same day as a preventive visit or a procedure. It is what allows a preventive-plus-problem visit to be paid for both components, but the documentation must clearly support the separate work.
What is an Annual Wellness Visit and how is it billed?
The Medicare AWV (G0438 for the initial, G0439 for subsequent) covers a personalized prevention plan. It is distinct from a routine physical, and practices commonly leave revenue behind by not capturing it or by conflating it with a problem visit.
What are CCM and RPM?
Chronic Care Management and Remote Patient Monitoring are separately billable programs for managing chronic conditions between visits. Both require specific time, consent and documentation criteria, and both are widely under-captured in primary care.
What is HCC risk adjustment and why does it matter?
Hierarchical Condition Categories drive risk-adjusted payment in Medicare Advantage and value-based contracts. Chronic conditions must be documented and coded to the correct specificity each year, so open HCC gaps directly reduce the practice's risk-adjusted revenue.