Medical billing & RCM services
Medical Billing & RCM So You Can Focus on Patients
Less administrative work, more time for your patients. CreatorLayer runs medical billing and revenue cycle management for U.S. healthcare providers, so you collect more, see fewer denials and run a calmer practice.
- HIPAA-aligned workflows
- BAA where required
- Works in your EHR & PM
Clean-claim target95%+
Overview — What We Do.
We handle the billing work between the patient visit and the payment, so your team can get back to patient care.
What we do
Reliable, accurate medical billing and revenue cycle management (RCM): claims, eligibility, authorizations, coding, payment posting, denials, A/R follow-up and patient billing.
How we work
A dedicated team works inside your own EHR, practice management system and clearinghouse during U.S. business hours, under a business associate agreement.
Who it’s for
U.S. physician practices, clinics, dental and behavioral health providers, and billing companies that need more hands without hiring in-house.
The Revenue Cycle — End To End.
Every step from appointment to payment, handled
Revenue is lost at the edges: a missed eligibility check, an authorization nobody requested, a code that does not match the note. We run the whole cycle so problems are stopped at the step where they start, not found weeks later as a denial.
- 01Patient registration
- 02Eligibility check
- 03Prior authorization
- 04Medical coding
- 05Charge entry
- 06Claim submission
- 07Payment posting
- 08Denials & A/R
- 09Patient billing
- 10Reporting
Our Core Services — Pick One Or All.
End-to-end RCM support tailored to your practice
Six services that cover the full revenue cycle. Take the whole set, or hand over only the parts that are costing you time and money.
Medical Billing & Claims
Medical billing and claims management
We turn every visit into a clean, payable claim. Charges are entered from your encounter notes, scrubbed against payer edits and sent electronically the same day, then tracked until they are paid or worked.
- Charge entry and charge-lag tracking
- Claim creation, scrubbing and submission (CMS-1500 / 837P)
- Electronic claims through your clearinghouse
- Claim status tracking and rejections fixed within one business day
- Payment posting from ERA/EOB, including secondary claims
- Daily billing reconciliation against your schedule
Insurance Verification & Authorization
Insurance eligibility verification and prior authorization
Most denials start before the patient is seen. We check coverage, benefits and authorization needs ahead of each appointment, so your team knows what is covered and what the patient owes before they arrive.
- Benefits and eligibility checks before every visit
- Copay, deductible and coinsurance confirmed
- Prior authorization requests, follow-up and tracking
- Referral support for HMO and managed-care plans
- Insurance and demographic updates in your system
- Coordination of benefits when a patient has two plans
Denial Management & A/R
Denial management and accounts receivable follow-up
Every denial is read, sorted by its reason code and worked: corrected and resubmitted, appealed with documentation, or escalated to the payer. Unpaid claims are followed up by phone and portal before they age past timely-filing limits.
- Denial identification and root-cause tagging by CARC/RARC
- Corrected claims, resubmissions and written appeals
- A/R follow-up by aging bucket (30, 60, 90, 120+ days)
- Payer calls and portal follow-up
- Underpayment detection against your fee schedule
- Aged A/R clean-up projects
Medical Coding Support
Medical coding support
Certified-coder review of diagnosis and procedure codes so claims match the documentation and payer rules. We flag missing documentation back to your providers instead of guessing.
- ICD-10-CM diagnosis coding
- CPT and HCPCS procedure coding
- Modifier checks (25, 59, XS and others)
- NCCI edit and bundling checks
- Documentation queries back to providers
- Coding error trends shared monthly
Patient Billing & Admin
Patient billing and administrative support
Patient balances are now a big share of practice revenue. We send clear statements, answer billing questions and follow up politely, and can take on the front-office admin that slows your team down.
- Patient statements and billing inquiries
- Payment reminders and payment-plan follow-up
- Appointment scheduling and confirmation calls
- Patient registration and data entry
- Insurance card and demographic capture
- Refunds and credit balance review
Reporting & Practice Support
Revenue cycle reporting and practice support
You see the numbers that matter every week, not a pile of exports. Each report shows what was billed, collected and denied, what is still owed and what we are doing about it.
- Daily, weekly and monthly reports
- Collections and denial-rate monitoring
- Insurance payment reconciliation
- Days in A/R and aging trends
- Payer mix and payer performance review
- Monthly revenue cycle performance summary
Denial Management — Worked, Not Written Off.
The denials we fix most often, and how
Every denial carries a claim adjustment reason code (CARC). We sort by code, fix the claim, and fix the step that caused it so the same denial stops coming back.
- CO-16
Missing or incorrect information
We correct the claim data (IDs, NPI, dates, modifiers) and resubmit, then fix the intake step that let it through.
- CO-197
Authorization or precertification missing
We request a retro-authorization where the payer allows it, appeal with notes, and add the service to the pre-visit auth check.
- CO-50
Not deemed medically necessary
We review diagnosis-to-procedure linkage and payer policy, then appeal with supporting documentation.
- CO-29
Timely filing limit expired
We look for proof of earlier submission to appeal, and prevent repeats by working claims before payer deadlines.
- CO-97
Bundled into another service
We check NCCI edits and modifier use, and correct and resubmit when the service was distinct.
- CO-18
Duplicate claim or service
We confirm whether the first claim is paid or pending before anything is resent, so nothing is double-billed.
- CO-22
Another payer may be primary
We confirm coordination of benefits with the patient and payers, then bill the correct primary plan.
- CO-45
Charge exceeds the fee schedule
Usually a contractual adjustment, not an error. We post it correctly and flag any payment below your contracted rate.
Onboarding — Live In About Three Weeks.
How we take over your billing without disruption
A structured handover means no gap in claims going out. Your current team or biller can work alongside us until go-live.
- Week 1
Free billing and A/R review
We look at a sample of your claims, denials and aging to see where revenue is leaking and what to fix first.
You geta short findings report with the quickest wins
- Week 1
BAA, access and security setup
We sign a business associate agreement, then get named user accounts in your EHR, PM system and clearinghouse. No shared logins.
You geta documented access list you control
- Week 2
Workflow mapping and payer setup
We map your charge-entry rules, payer requirements, fee schedules and authorization needs into a written process.
You geta billing SOP written for your practice
- Week 3
Go-live with daily work
Charges, claims, eligibility checks and payment posting run every business day during US hours, led by a named billing lead.
You getone point of contact and a daily task log
- Ongoing
Weekly A/R and monthly reviews
We review denial trends, payer issues and aging with you, and fix root causes rather than just resending claims.
You getweekly A/R reports and a monthly RCM summary
In-House vs Outsourced — Side By Side.
In-house billing or CreatorLayer?
Many practices start with one in-house biller. Here is how that compares with handing the revenue cycle to a dedicated team.
| What matters | In-house biller | CreatorLayer |
|---|---|---|
| Cost | Salary, benefits, payroll tax, training and extra software seats | One predictable fee, scoped to your claim volume and services |
| Coverage | Billing slows or stops when someone is sick, on leave or resigns | A team covers every business day, so there is no single point of failure |
| Expertise | One person juggles coding, payer rules, appeals and A/R | Specialists for coding, denials and A/R, led by one named billing lead |
| Denials and A/R | Worked when there is time, often close to filing deadlines | Worked daily by reason code, well before timely-filing limits |
| Hiring and training | Recruit, train and re-train after every staff change | A trained team working in your system in about three weeks |
| Reporting | Exports and spreadsheets pulled together on request | Weekly A/R reports and a monthly revenue cycle summary |
| Growth | More providers or locations means another hire | Capacity grows with your claim volume, without new headcount |
| Control | Your systems and your data | Still your systems and your data, plus an access list you control |
Not sure which suits your practice? We will compare it with your current numbers in a free billing review.
Get a Free Billing ReviewWhy Partner With Us — CreatorLayer.
Why practices partner with CreatorLayer
One accountable team for the whole revenue cycle, measured on what you collect.
Higher collections
Fewer denials, faster follow-up and underpayments caught, so more of what you bill is paid.
Less administrative load
Your staff stop chasing payers and spend that time with patients instead.
Accurate and compliant
HIPAA-aligned processes, certified coding review and a BAA where required.
Flexible and scalable
From solo practitioners to growing multi-location groups, without hiring in-house.
Dedicated support
A named billing lead who knows your practice, your payers and your goals.
See where every dollar is
Weekly A/R and monthly revenue cycle summaries show what was billed, paid, denied and still owed, by payer and by aging bucket, with the actions we are taking.
- Collections and denial-rate trends
- Days in A/R and aging by payer
- Insurance payment reconciliation
Specialties — We Support All Major Ones.
Medical billing for every major specialty
Each specialty has its own codes, modifiers and authorization rules. We map yours during onboarding, so billing follows your payers’ rules from day one.
- Family Medicine
- Internal Medicine
- Cardiology
- Dermatology
- Orthopedics
- Dental Practices
- Behavioral Health
- Pediatrics
- Physical Therapy
- Chiropractic
- Urgent Care
- Pain Management
- Gastroenterology
- OB/GYN
- Neurology
- Podiatry
- And more
Systems we work in
- Epic
- athenahealth
- eClinicalWorks
- NextGen
- AdvancedMD
- Tebra (Kareo)
- DrChrono
- CareCloud
- ModMed
- Practice Fusion
- Office Ally
- Availity
- Waystar
- TriZetto
- Dentrix
HIPAA & Security — Protected By Design.
Patient information stays protected
Patient information is protected through secure systems and business associate agreements (BAA) where required. These are the rules every person on your account follows.
- A business associate agreement (BAA) is signed before anyone touches patient data
- Named individual logins only, never shared credentials
- Access limited to the minimum each task needs
- Work happens inside your systems; patient data is not copied out
- Staff complete HIPAA privacy and security training
- Access is removed the same day an engagement or role ends
Fit — An Honest Answer.
Is outsourced medical billing right for you?
A good fit if
- You run an independent practice or group and billing is pulling staff away from patients
- Denials are rising, or A/R older than 90 days keeps growing
- You lost an in-house biller and need cover without a long hiring process
- You are a billing company that needs trained overflow capacity
Probably not if
- You need staff physically on-site in your office
- You want someone to bill without access to your EHR or PM system
- You are looking for a software product rather than a team doing the work
Not sure? Ask us and we will tell you honestly.
Ready to simplify your revenue cycle?
Let’s work together.
Partner with CreatorLayer for a smarter, more efficient way to manage your billing. Start with a free review of your claims and A/R.
What is revenue cycle management (RCM) in medical billing?
Revenue cycle management is every step between a patient booking a visit and the practice being fully paid: registration, eligibility and authorization checks, coding, charge entry, claim submission, payment posting, denial management, A/R follow-up and patient billing. Medical billing is the claims part of that cycle; RCM manages the whole cycle so fewer claims are denied in the first place.
What medical billing services does CreatorLayer provide?
We cover the full revenue cycle for US practices: medical billing and claims management, insurance eligibility verification and prior authorization, denial management and A/R follow-up, medical coding support, patient billing and front-office admin, and revenue cycle reporting. You can outsource the whole cycle or only the parts your team struggles with.
Is your medical billing service HIPAA compliant?
Our processes are built to HIPAA requirements. We sign a business associate agreement (BAA) where required before we access any patient information, use named individual logins rather than shared accounts, limit access to the minimum each task needs, work inside your own systems, and remove access the same day it is no longer needed.
Which EHR and practice management systems do you work with?
We work inside the system you already use, so nothing about your setup has to change. Common examples include Epic, athenahealth, eClinicalWorks, NextGen, AdvancedMD, Tebra (Kareo), DrChrono, CareCloud and ModMed, plus clearinghouses such as Availity, Waystar, Office Ally and TriZetto. If yours is not listed, ask us.
How long does it take to get started?
Most practices are live in about two to three weeks. Week one covers a free billing and A/R review, the BAA and system access. Week two maps your payer rules and billing workflow. Daily work starts in week three, with a named billing lead as your contact.
How do you reduce claim denials?
By fixing the front end, not just reworking claims. We verify eligibility and authorizations before visits, check codes and modifiers against payer and NCCI edits, scrub claims before submission, and tag every denial by its reason code (such as CO-16, CO-197 or CO-50) so the root cause is fixed and the same denial does not come back.
Can you work on old, aged A/R?
Yes. We run A/R clean-up projects that sort unpaid claims by value and timely-filing deadline, work the recoverable ones first by phone, portal and appeal, and report what was collected, adjusted or written off so your books are accurate.
Which medical specialties do you support?
We support most outpatient specialties, including family and internal medicine, cardiology, dermatology, orthopedics, dental practices, behavioral health, pediatrics, physical therapy, chiropractic, urgent care, pain management and more. Each specialty has its own coding and authorization rules, which we map during onboarding.
How much do outsourced medical billing services cost?
Pricing depends on your claim volume, specialty and how much of the revenue cycle you hand over. We quote after a free review of your current billing, so the price reflects the actual work. Request a quote and we will come back with a clear proposal.
Will I still see what is happening with my billing?
Yes. Everything is done in your own systems, and you get weekly A/R reports plus a monthly revenue cycle summary covering collections, denials, days in A/R and aging, with a named billing lead you can reach directly.
We’re proud to hold a 4.9 average rating from 80+ brand partners
That rating comes from how we work: every engagement gets a dedicated point of contact, a shared reporting dashboard, and campaigns tied to a KPI agreed with you before work starts. It is also why 98% of our clients stay with us. When you’re ready for the same level of attention on your brand, tell us what you need and we’ll handle the rest.
Free quote. No obligation.
- Client retention
- 98%
- Brand partners served
- 80+
- Performance specialists
- 10+
- Years of experience
- 15+
