Independent providers can increase reimbursements by improving eligibility, coding, denials, and EHR workflows. DelonHealth powers it end-to-end

You didn’t open your practice to become a part-time claims chaser. Yet for many independent providers in the U.S., from primary care and behavioral health to PT/OT/ST (Occupational Therapy, Physical Therapy, and Speech-Language Therapy, respectively) and specialty clinics, reimbursements feel unpredictable. The truth is, you don’t need a bigger billing team; you need a tighter system.

This guide shows you how to turn clinical encounters into clean revenue with practical, step-by-step tactics you can implement in days—not months. And where it’s faster or smarter to bring in a partner, we’ll show you how DelonHealth plugs into your EHR and workflows to make billing feel invisible while cash moves faster.

The Three Levers of Reimbursement

Every dollar you’re owed is won or lost across three levers:

• Front-end accuracy: patient registration, eligibility/benefits, authorization, financial policy, and point-of-service collections.
• Mid-cycle precision: documentation, coding, charge capture, and claims scrubbing.
• Back-end intensity: denial analytics, appeals, underpayment recovery, ERA posting, patient billing, and payment plans.

Master these, and you’ll see predictable cash, fewer write-offs, and happier staff.

• Patient Registration: Capture It Right, Get Paid Sooner

Messy demographics break claims later. Fix the first mile.

What to do now

• Use digital intake with required fields (name, DOB, address, phone, email, insurance plan, member/subscriber ID).
• Scan both sides of the insurance card; capture government ID; verify spelling at check-in.
• Ask about secondary insurance and coordination of benefits (COB).
• Obtain updated consents (HIPAA, assignment of benefits, financial policy) every year.

• Insurance Eligibility Verification & Benefits Estimation

Eligibility denial is the #1 preventable rejection.

Checklist

• Run electronic eligibility (270/271) at scheduling and day-of-service.
• Confirm network status, copay, deductible (met vs. remaining), coinsurance, and visit limits.
• Flag referrals and prior auth requirements by payer + CPT.
• Calculate a benefit estimate and discuss expected patient responsibility at check-in.

Pro tip: Document the rep name/portal screenshot for high-risk payers; it helps during appeals.

DelonHealth fit: We automate checks, surface real-time benefits in your EHR, and enable point-of-service collections with clear language that staff can use.

• Prior Authorization Without the Headaches

No auth = automatic denial in many plans.

Workflow

1. Trigger: EHR orders or appointment type triggers an auth check.
2. Packet: Include clinical notes, CPT/HCPCS, ICD-10-CM, and medical necessity.
3. Track: Log auth number, effective dates, units/visits, site of service, and attach to the encounter.

DelonHealth fit: We set up payer-specific auth rules, build packets, and manage follow-ups so authorizations don’t become a bottleneck.

• Medical Terminology & Documentation That “Supports the Code”

Payers don’t pay for what was done; they pay for what was documented.

Make documentation do the work

• Use precise terminology that aligns with medical necessity (onset, severity, duration, response to treatment).
• Avoid vague phrases (“follow-up, stable”). Instead, record HPI elements, exam details, and MDM specifics.
• For therapy and behavioral health, include time, goals, modalities, progress, and plan.

DelonHealth fit: We provide specialty quick-reference guides and micro-coaching to make “documentation that supports the code” the default.

• Medical Coding: E/M, Modifiers, NCCI Edits, and Specialty Nuances

Coding precision is revenue.

Essentials

• E/M leveling: For office visits, ensure the note supports level selection (MDM/time).
• Modifiers: 25 (significant, separately identifiable E/M), 59/XS (distinct procedural service), 95 (telehealth), 59-family edits—apply correctly.
• NCCI edits: Don’t bill code pairs that bundle unless justified with correct modifiers.
• ICD-10-CM specificity: Use laterality, episode of care, and causal links as applicable.
• Behavioral health/therapy: Document time-based codes correctly; watch visit limits and documentation requirements.

DelonHealth fit: Certified coders do pre-bill audits, correct modifiers, and update rules quarterly as payer policies change.

• Claims Processing: From 837P to Clean Claim Rate

A clean claim goes through the clearinghouse and payer with no hiccups.

Tactics

• Charge capture same day; don’t let “DNFB” (discharged not final billed) grow.
• Scrub claims for missing data, NPI/taxonomy, place of service, authorization numbers, and policy-specific edits.
• Submit electronically (837P) and work clearinghouse rejections within 24–48 hours.
• Monitor timely filing limits per payer (mark them in your worklist).

DelonHealth fit: We configure claim scrubbers, manage rejection queues to zero daily, and maintain payer-specific edit libraries.

• Adjudication & Underpayments: Read the Story in the ERA

The remittance (835) tells you what the payer allowed, adjusted, and assigned to the patient.

What to watch

• Remark codes → next action (bill patient, appeal, correct & resubmit).
• Contract variance → underpayments vs. fee schedule; queue for recovery.
• Ensure EFT enrollment so funds land quickly, and match deposits to posted ERAs daily.

DelonHealth fit: We auto-post with human QA, flag underpayments by CPT & payer, and pursue recoveries with documentation.

• Denial Management: Treat “No” Like a Signal

Denials fall into families: eligibility, authorization, medical necessity, bundling/edits, documentation, duplicate, non-covered, and timely filing.

Denial playbook

1. Taxonomy: Classify CO-/PR- codes by reason & payer.
2. Prioritize: Attack the top three families first.
3. Appeal: Use payer-specific templates, evidence, and timelines.
4. Prevent: Close the loop with front-end/mid-cycle fixes so it doesn’t recur.

DelonHealth fit: We run denial analytics, produce appeal kits, and build prevention sprints that lower denial rates over time.

• Duplicate Billing: Small Mistake, Big Consequences

Duplicates trigger rejections, delay cash, and can invite audits.

Prevention

• System rules to block duplicates at submission.
• Separate corrected claims from originals; use appropriate resubmission codes.
• Train staff on status logic to avoid accidental re-sends.

DelonHealth fit: We configure controls and monitor patterns that look like duplicates even across locations.

• Patient Statements & Payment Plans That Actually Collect

Patient responsibility has grown. Clarity and convenience win.

Do this

• Send plain-language statements: what was done, what insurance paid, what remains, and why.
• Move to rolling cycles (not once a month) to accelerate cash.
• Offer digital delivery (email/SMS) with tap-to-pay links.
• Set up card-on-file and tiered payment plans with automated reminders.

DelonHealth fit: We modernize statements, enable portals, and manage payment plans to increase patient yield ethically.

• Electronic Health Records (EHRs): Make the System Work for You

Most EHRs can do more than we ask of them.

Quick wins

• Turn on eligibility, charge capture, claim scrubber, and ERA posting features.
• Tune templates so they collect what coding needs (and nothing extra).
• Reduce swivel-chair work with interfaces, defaults, and role-based queues.

DelonHealth fit: We’re EHR-agnostic and optimize what you already use—no rip-and-replace.

• Compliance: HIPAA, No Surprises Act, and Payer Policies

Get paid—and be audit-ready.

Foundations

• HIPAA privacy/security safeguards; role-based access and audit logs.
• Follow No Surprises Act requirements (good-faith estimates for self-pay/uninsured, balance billing rules for certain services).
• Keep BAAs current; document your policies & training.
• Stay current with payer policies and LCD/NCD coverage rules relevant to your specialty.

DelonHealth fit: We embed compliance checks and maintain audit-ready documentation across workflows.

• Revenue Cycle KPIs Every Independent Practice Should Track

Measure what matters weekly and monthly:

• Clean Claim Rate (CCR) – % submitted without edits/rejections
• First-Pass Acceptance – % paid on first submission
• Denial Rate – % of claims denied (and top denial families)
• Days in A/R – overall and by payer
• Net Collection Rate – collected vs. allowed
• Underpayment Recovery – identified vs. recovered
• DNFB – charges waiting to be billed
• Patient Yield – % collected from patient-responsible balances

DelonHealth fit: We implement dashboards and run the cadence—weekly huddles, monthly executive reviews—so trends don’t surprise you.

• Technology in Medical Billing: Automate the Repeatable

Let software do the busywork so humans handle exceptions.

• Eligibility (270/271), Claim status (276/277), Claims (837), Remits (835) over EDI.
• Rules engines for edits/scrubbing.
• Bots for status checks and ERA posting.
• Analytics for denial drivers, AR aging by payer/CPT, and underpayment detection.
• Secure portals and role-based access to protect PHI.

DelonHealth fit: We set up the rails and handle monitoring so you don’t have to manage yet another system.

When to Outsource (and How DelonHealth Helps)

Consider outsourcing when

• Growth outpaces in-house bandwidth.
• Denials and aged A/R keep climbing.
• You’re launching new services (telehealth, IOP/PHP, procedures) with complex rules.
• Recruiting/retaining billing specialists is difficult.

DelonHealth engagement models

• Full RCM: front-end to back-end operations.
• Co-sourcing: we complement your in-house biller(s).
• Project-based: coding only, denials blitz, old A/R cleanup, credentialing.

What you keep: your EHR, your data, and full visibility—plus SLAs, dashboards, and a single point of contact.

Mini Case Snapshot

Practice: Multi-location behavioral health group (independent providers network).
Challenges: Eligibility denials, weak documentation for time-based codes, slow patient payments.
DelonHealth actions:

• Automated eligibility + auth screening; front-desk scripts.
• Documentation, quick guides, and coding pre-bill audits.
• Claim scrubber tuned to top payers; rejections cleared within 24–48 hours.
• Digital statements, card-on-file, and tiered payment plans.
  Results (after 90 days):
• Clean Claim Rate up significantly; denial rate down.
• Days in A/R reduced; patient collections improved.
• Provide satisfaction up; staff time reclaimed from manual tasks.

(Results vary by baseline; ask us for anonymized, specialty-specific snapshots.)

• Frequently Asked Questions

Q1: We’re a small practice. Can we really improve reimbursements without hiring more staff?
Yes. Front-end and mid-cycle fixes (eligibility, documentation, coding, scrubbing) reduce rework. Automation and better queues shift staff to exceptions instead of busy work.

Q2: Our EHR already has billing tools. Why bring in a partner?
Most EHRs are underused. A partner like DelonHealth tunes the tools, adds payer-specific rules, and runs the operational cadence (denials, appeals, underpayments) consistently.

Q3: How fast can we see results?
Eligibility/auth + coding/scrubber improvements typically show in the first 30–60 days through higher first-pass acceptance and fewer rejections.

Q4: Will we lose visibility if we outsource?
No. You keep your systems and data. We provide dashboards, weekly updates, and clear SLAs.

Q5: We’re mostly telehealth. Anything special we should do?
Use the correct place of service, ensure modifier 95 when required, verify coverage for telehealth by payer, and confirm patient location rules at the time of service.

Next Steps & How to Work With DelonHealth

If your reimbursement feels like guesswork, let’s turn it into a system that quietly delivers.

Start with a free revenue cycle assessment:

• Eligibility & auth gaps
• Documentation & coding risks
• Denial families and top drivers
• Underpayment exposure
• Patient billing opportunities

Then choose your path:

• Pilot DelonHealth on a single payer or service line.
• Co-source denials and old A/R while we lift the front door.
• Full RCM for end-to-end performance with clear KPIs.

DelonHealth | US Medical Billing & RCM for Independent Providers
Fewer denials. Faster payments. Happier patients. Invisible billing.

Quick Reference: Checklists You Can Use Today

Front-End (Daily)

• ☐ Verify demographics + insurance at every visit
• ☐ Run eligibility at scheduling + day-of
• ☐ Confirm auth/referral status
• ☐ Discuss estimate + collect card-on-file

Mid-Cycle (Weekly)

• ☐ Pre-bill coding audit (E/M level, modifiers, NCCI)
• ☐ Scrubber rules updated for top payers
• ☐ Rejections worked to zero within 48 hours

Back-End (Weekly/Monthly)

• ☐ Denials classified and appealed on time
• ☐ Underpayments flagged and pursued
• ☐ Rolling statements + payment plans active
• ☐ KPI dashboard reviewed (CCR, denials, A/R, NCR)

Ready to make billing invisible so you can focus on care?
Reply with “Assessment” and we’ll schedule a quick call to map your fastest wins.

DelonHealth — Contact Us
Address: 45 Dan Road, Suite 125, Canton, MA 02021, United States
Email: info@delonhealth.com
Phone: +1 (508) 455-0015
Alternate: +1 (508) 455-0095
Website: delonhealth.com