Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...
Hospital Billing & Revenue Cycle Services
Institutional billing runs on UB-04 claims, chargemasters, DRGs and APCs. Specialist hospital billers protect revenue from registration to final payment.
- Inpatient DRG and outpatient APC coding expertise
- Chargemaster reviews and missed-charge recovery
- Clinical denial appeals and payer contract audits
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What hospital billing involves
Hospitals and health systems bill on the institutional claim (UB-04/837I) using revenue codes, HCPCS and ICD-10-PCS procedure codes, condition and value codes. Inpatient stays are paid by diagnosis-related groups (MS-DRG for Medicare), while outpatient services are paid under APCs and fee schedules, each with different rules.
Revenue leakage in hospitals comes from many places: outdated chargemaster items, departments that fail to post charges, documentation that does not support the highest appropriate DRG, and clinical denials for medical necessity or level of care. Even small percentages represent large dollars at hospital scale.
A hospital billing partner combines patient access support, coding and CDI, charge capture audits, claim edits, denial management and contract-based underpayment recovery, often working alongside your existing team to clear backlogs and raise performance.
Common hospital billing billing challenges
DRG and APC accuracy
Coding and documentation directly determine DRG and APC assignment and payment.
Chargemaster maintenance
Outdated CDM lines cause rejected claims and missed revenue across departments.
Clinical and level-of-care denials
Payers deny inpatient stays as observation-level or not medically necessary.
Late charge posting
Departments that post late hold claims or miss filing deadlines.
Complex payer contracts
Carve-outs, outliers and case rates make underpayments hard to detect.
Staffing shortages
Coding and billing backlogs grow quickly when experienced staff are hard to hire.
What a hospital billing billing partner should handle
- Patient access and insurance verification support
- Inpatient ICD-10-CM/PCS coding and DRG validation
- Outpatient, ED and observation coding
- Clinical documentation integrity support
- Chargemaster review and charge capture audits
- UB-04 claim edits and submission
- Clinical and technical denial appeals
- Contract modeling and underpayment recovery
- Aged A/R and backlog clean-up
- Executive revenue cycle dashboards
Key elements of hospital claims
| Element | Purpose |
|---|---|
| UB-04 / 837I | Institutional claim format used by hospitals and facilities. |
| Revenue codes | Four-digit codes such as 0450 (emergency room) or 0360 (operating room) grouping charges by department. |
| MS-DRG | Medicare inpatient payment groups based on diagnoses, procedures and complications. |
| APC / OPPS | Outpatient prospective payment groups for hospital outpatient services. |
| ICD-10-PCS | Inpatient procedure coding system used for DRG assignment. |
| Condition & value codes | Claim fields describing circumstances like accidents or patient status that affect payment. |
Hospital billing rules differ by payer contract and state; examples are for orientation only.
Compliance across the enterprise
Hospital billing must align with CMS conditions of payment, the two-midnight rule, NCCI edits and price-transparency requirements. A partner should support compliance audits and keep detailed records of coding decisions.
Find the right billing partner in four steps
Share your goals
Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.
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We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.
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Top-rated medical billing companies
Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their hospital billing experience.
GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: • Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. • Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. • Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. • Financial Solutions - Data-driven insights and financial reporting to optimize practice...
Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...
Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...
How much does hospital billing billing cost?
Hospital revenue cycle services are usually priced by scope: percentage of collections for full outsourcing, contingency fees for denial and underpayment recovery projects, or per-chart rates for coding.
Most common. You pay only on money collected.
Predictable for high-volume, low-complexity claims.
Dedicated billers working inside your systems.
Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.
Hospital Billing billing FAQs
Hospital (institutional) billing uses the UB-04 claim with revenue codes and is paid under DRGs and APCs; physician (professional) billing uses the CMS-1500 claim and fee schedules.
By improving patient access accuracy, prior authorization, documentation for medical necessity and level of care, and claim edits, and by analyzing denial root causes regularly.
Many hospital RCM companies offer inpatient and outpatient coding, coding audits and CDI support separately from full billing.
A review of the hospital’s charge description master to correct outdated codes, prices and revenue-code mappings that cause rejections or missed revenue.
Yes. Contract-modeling tools compare expected and actual payments and identify underpaid claims for appeal.
Typically a percentage of collections for full outsourcing, or contingency or per-chart fees for specific projects.
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