Outsource Primary Care Billing and Prioritize Patient Well-being
Primary care medical billing is specialty billing and revenue cycle work built for family medicine and general practices where an E/M visit leveled too conservatively, a wellness visit and a problem visit billed on the same day without a modifier, or an immunization administration left off the claim is the difference between full payment and revenue quietly slipping away across a busy schedule.
EverCure Billing handles the complete revenue cycle for primary care physicians across the United States: eligibility and benefit checks, E/M and preventive coding, chronic care and transitional care billing, claim submission, denial appeals, and aged A/R recovery. Your team cares for the patient. We make sure the visits, preventive services, and chronic conditions you already documented actually get paid and hold up if a payer looks.
What Is Primary Care Medical Billing?
Primary care medical billing covers every financial step between a patient booking a visit and that money landing in your practice account.
For a primary care practice specifically, that includes verifying coverage and preventive-service eligibility, leveling each E/M visit correctly by medical decision making or time, separating preventive and problem-oriented services billed on the same day, capturing chronic care management and transitional care where you actually provided it, coding immunizations and their administration, coding every active condition to the correct specificity, submitting a clean claim, posting the payment, appealing the denial, and chasing the balance until it clears.
General billing stops at "submit the visit." Primary care billing runs on E/M accuracy, preventive-vs-problem logic, care-management programs, and immunization capture the exact places where primary care quietly under-collects across high patient volume.
Why Do Primary Care Practices Lose More Revenue Than They Should?
Because primary care revenue lives in E/M levels, same-day preventive-plus-problem visits, care-management programs, and immunization capture all of which are easy to under-bill when the schedule is full. These are the specific leaks we see when we run audits on primary care practices:
E/M downcoding and conservative leveling
Under the current E/M rules, visits level on decision making or time and practices routinely bill a level below what the documentation supports, out of caution. Across a full panel, that's real money on every complex visit.
Preventive-and-problem same-day errors
When a wellness or preventive visit and a problem-oriented E/M happen on the same day, the problem visit is billed with modifier 25. Miss the modifier or drop the problem visit and the practice under-collects on a visit it earned.
Uncaptured chronic care management (CCM) and transitional care (TCM)
Primary care provides non-face-to-face management of chronic patients and post-discharge care constantly but if it isn't coded to the CCM and TCM codes, none of it is paid.
Missed annual wellness visits
Medicare AWVs (G0438/G0439) are frequently billed as ordinary visits, leaving a covered, well-paid service on the table.
Immunization administration gaps
Vaccine administration is separately billable from the vaccine itself, and is one of the most commonly dropped charges in primary care.
Diagnosis-specificity gaps
Under-specified diagnoses cause denials and, for value-based and Medicare Advantage panels, cost the practice on risk adjustment.
We build the workflow around these six failure points, because they are where primary care revenue actually disappears.
What Primary Care Billing Services Does
EverCure Billing Provide?
Insurance eligibility and benefits verification
We verify active coverage, plan type, deductible and coinsurance status, and preventive-service eligibility before the visit.
Prior authorization support
We prepare and submit authorization requests where the payer requires them for imaging, procedures, or medications, and follow up until a decision is issued.
Primary care coding
Our coders work from your notes to level each E/M correctly, separate preventive and problem services, code CCM and TCM where provided, code immunization administration, and code each condition to the correct specificity. Coding and billing are handled together, so coding errors are caught before the claim goes out.
Charge entry and claim scrubbing
Every claim runs through a pre-submission check for E/M-level support, modifier 25 logic, care-management requirements, immunization administration, and diagnosis-to-service linkage before it leaves our office.
Claim submission and clearinghouse management
Electronic submission, rejection handling at the clearinghouse level, and same-day correction and resubmission on front-end rejects.
Payment posting and reconciliation
ERA and manual EOB posting, contractual adjustment verification, and underpayment identification.
Denial management and appeals
Every denial is categorized by root cause, corrected, and appealed with the documentation the payer is actually asking for. We also feed denial patterns back into coding so the same denial stops repeating.
Accounts receivable follow-up and recovery
Structured follow-up on aged claims by bucket (30 / 60 / 90 / 120+ days), with priority given to high-dollar claims and anything approaching a timely filing deadline.
Patient billing and support
Clear patient statements, balance explanations, and a support line so your front desk isn't spending its day explaining coverage.
Provider credentialing and payer enrollment
New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment through PECOS.
Billing audits and compliance review
Periodic internal review of E/M leveling, modifier 25 usage, and care-management documentation to reduce audit exposure before a payer finds it first.
Financial reporting
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, and payer performance in plain language, not a data dump.
Which Primary Care Services
Do You Bill?
Office and outpatient E/M visits new and established patient visits, leveled to the documentation by MDM or time.
Preventive medicine visits well-child checks, adult physicals, and preventive counseling, billed alongside a problem visit where both occurred.
Medicare annual wellness visits the initial and subsequent AWV, coded correctly rather than as an ordinary visit.
Chronic care management non-face-to-face management of patients with multiple chronic conditions, billed to the CCM codes.
Transitional care management post-discharge management billed to the TCM codes within the required window.
Immunizations and vaccines administration billed separately from the vaccine, for both pediatric and adult schedules.
Smoking cessation and preventive counseling billed to the correct time-based counseling codes.
Which Primary Care CPT and ICD-10 Codes
Do You Work With?
| Code / Range | What It Covers |
|---|---|
| 99202–99215 | New and established patient office / outpatient E/M |
| 99381–99397 | Preventive medicine visits (new / established, by age) |
| G0438 / G0439 | Medicare annual wellness visit (initial / subsequent) |
| 99490 / 99491 | Chronic care management |
| 99495 / 99496 | Transitional care management |
| 90460–90474 | Immunization administration |
| 90471–90474 | Vaccine / toxoid administration |
| 99406 / 99407 | Smoking / tobacco cessation counseling |
| E11.- | Type 2 diabetes mellitus |
| I10 | Essential hypertension |
| E78.5 | Hyperlipidemia |
| Z00.- | General adult / child health examination |
Code sets and E/M documentation rules update over time, and risk-adjustment mappings change annually. Keeping current on all of it is part of the service, not an extra.
Which Modifiers and Codes Actually Decide
Whether a Primary Care Claim Gets Paid?
The theme in primary care is that E/M level accuracy, modifier 25 discipline, and diagnosis specificity decide payment far more than any procedure code. That's exactly what we scrub before submission.
Significant, separately identifiable E/M. The single most important modifier in primary care: it lets a problem visit be paid on the same day as a preventive visit or a minor procedure. Heavily reviewed, so it has to be documented properly.
More than any modifier, choosing and supporting the correct 99213 vs 99214 vs 99215 decides how much a visit pays. This is where most primary care revenue is won or lost.
Preventive service. Identifies a covered preventive service so patient cost-sharing is applied correctly.
Distinct procedural service. Used to correctly separate legitimately distinct services under bundling edits.
ABN on file / non-covered. Used to route patient responsibility correctly.
Not a modifier, but the biggest quiet lever in primary care coding conditions to full specificity drives clean claims and correct risk adjustment.
How Does Compliance Work in Primary Care Billing?
E/M leveling discipline
Levels are only defensible when MDM or time supports them. We hold each visit to the documentation standard so appropriate levels stand up instead of being downcoded and upcoding risk is avoided.
Modifier 25 discipline
Same-day E/M-plus-service combinations are audited patterns. We hold the modifier to the documentation standard so combined visits are paid correctly and survive scrutiny.
Care-management requirements
CCM and TCM carry specific time, consent, and timing requirements. We track them so the codes are supported.
Medical necessity and diagnosis linkage
We link each diagnosis to its service and code conditions to specificity so claims aren't submitted unsupported.
HIPAA and data security
Every EverCure Billing team member works under signed HIPAA agreements with role-based access to PHI, secure data transfer, and no PHI on personal devices or unsecured channels.
How Does the
Onboarding Process Work?
Free billing audit
We review a sample of recent claims, denials, and your aged A/R to identify where revenue is being lost and how much is recoverable.
Findings and scope
You get a written summary of what we found and a clear proposal services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical team.
Workflow mapping
We document your visit mix, top payers, care-management programs, immunization volume, and current denial patterns, then build the billing workflow around how your practice actually runs.
Go live
Claims start flowing through our process. In parallel, we begin working your existing aged A/R.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager, and a scheduled review call.
Typical onboarding runs about two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly in your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, DrChrono, Practice Fusion, CareCloud, Epic, and Cerner.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide.
What Does Primary Care Billing Cost?
Our primary care billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on visit volume, payer mix, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. If you want a specific number, the Business Assessment is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for Primary Care Billing?
We code and bill together.
In primary care, most lost revenue is a coding decision a downcoded visit, a missing modifier 25, a dropped immunization charge. Handling coding and billing in one workflow means those errors are caught before the claim drops.
We capture the whole visit, not just the office code.
Preventive-plus-problem visits, CCM, TCM, and immunization administration take real attention. That's the work we don't drop it.
You get a named account manager, not a ticket queue.
One person who knows your practice, your payers, and your patient panel.
Direct access to leadership.
When something goes wrong, you're not escalating through four layers.
Denial data goes back into coding.
Every denial reason is tracked and fed back upstream so the same error stops repeating.
Transparent reporting.
You see clean claim rate, denial rate by reason, days in A/R, and collections every month.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Primary Care Practice Leaving Money on the Table?
Most primary care practices don't know their true E/M distribution, how much preventive-and-problem revenue they're missing, or how much of their aged A/R is still collectible until someone actually looks.
That's what the Business Assessment is for. We review your recent claims, denials, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Primary Care Billing
Yes. We level each visit by MDM or time against the documentation, so complex visits are paid at the level they support instead of being downcoded.
Yes. We apply modifier 25 correctly so a problem visit is paid alongside a wellness visit when both occurred and are documented.
Yes. We capture CCM and TCM to the correct codes and track the time and timing requirements each one carries.
Yes. Vaccine administration is billed separately from the vaccine on both pediatric and adult schedules one of the most commonly dropped charges, which we catch.
Yes. We handle both together, which is how coding errors get caught before submission rather than in an audit.
Yes. We code conditions to full specificity, which supports both clean claims and correct risk adjustment.
Yes. New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment are all available.
Yes. We log into your current system and work inside it. There is no software to buy and no migration required.
Both. Aged A/R is usually where the fastest recovery is available.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.
Ready to Fix Your Primary Care Revenue Cycle?
Every downcoded visit and every aged account is money your practice already earned. Let's go get it.