Medical Billing Companies & Consultants in San Francisco, CA

Clarity RCM is a revenue cycle management firm that works only with independent dermatology practices. It does not serve multi-specialty groups or general medical clinics. For physician-owners and practice managers who want a billing partner that already knows how skin-care practices make money, it offers an outsourced billing department that runs the full cycle, from payer enrollment to final collection.

Background and focus

The company traces its origins to its founder's wife, a dermatologist who could not find a billing partner that understood private dermatology practice. Before founding the company, the founder and CEO worked in technology at Apple and Airbnb, and the firm describes its approach as data tools combined with staff who specialize in the specialty.

Clarity says it handles about $1.46 billion in yearly dermatology charges for 205 practices in multiple states. Its billing rules and denial tracking are built from that client base.

Services offered

• Full dermatology billing, including charge entry, claim scrubbing, same-day submission, payment posting and A/R follow-up
• Certified dermatology coding for excisions, biopsies, repairs, Mohs stages, pathology components and modifiers such as 25, 59 and KX
• Denial management with root-cause review, corrections and written appeals
• Credentialing and payer enrollment
• Compliance chart audits and help with TPE, RAC, UPIC and ADR reviews
• Patient statements and billing support
• Revenue strategy, payer contract guidance, provider compensation and practice valuation advice
• Reporting dashboards and peer benchmarking

A key part of the coding work is keeping cosmetic and medical services apart. Coders compare medical-necessity documentation with each diagnosis and send elective procedures to self-pay. When a note does not support a code, the coder asks the provider before the claim goes out rather than fixing it after a denial.

How engagements work

Onboarding starts with a free audit of the practice's receivables. Clarity then sets up its workflows inside the practice's existing practice management and EMR software, so the practice does not have to change systems. Each client gets a named Senior Account Manager and a dedicated billing pod rather than a call center.

Older outstanding claims are taken over from the first day at no added fee, and live dashboards show the status of each claim. Strategic advice is included in the engagement instead of being billed separately.

Platform and reported results

Alongside its services, the firm is building its own software. ClarityPay, currently in beta, handles patient statements and balance collection. ClarityOS, which has a waitlist, is meant to show live practice financials. Clarity reports that its clients average a 97 percent net collection rate, 27 days in receivables, and a first-pass clean claim rate of about 98 percent.

These figures come from the company and can be useful when comparing dermatology billing vendors. Clarity also says its workflows meet HIPAA requirements and use encryption and role-based access controls.

Doctors Billing Service (DBS) is a medical billing firm in San Francisco. Its legal name is BC Kats Inc. The firm works with physicians, specialists and healthcare clinics, from single-doctor offices to multi-specialty groups. It offers practices a way to hand off billing instead of running an in-house billing department. Practices that use DBS can hire and train fewer billers, and they don't need to buy or maintain their own billing software.

Background and leadership

Caroline Kats founded the company and still runs it. She has more than two decades of experience in medical billing. Before that, she managed multi-specialty medical offices, so she understands both what providers need on the administrative side and what patients experience. Kats oversees client accounts herself rather than passing them to an outside processing team. One long-term client is a podiatry group in the Bay Area with four physicians, which has used her for its billing for five years.

Core billing services

DBS covers the whole revenue cycle, from checking a patient's coverage before a visit to collecting the last balance. Its services include:

• Claims prepared and sent every day, electronically or on paper, depending on what each payer accepts
• Eligibility and insurance coverage checks before claims go out
• Coding review of ICD-10 and CPT codes and modifiers, plus scrubbing before submission
• Charge entry and payment posting, with payments compared to expected rates
• Tracking, correcting and appealing claims that were rejected, denied or left unpaid
• Patient statements and management of patient balances
• Weekly and monthly reports on aging, collections and payer activity

The firm also handles workers' compensation, surgical and Medicare claims. It files paper claims with insurers that can't take electronic billing, and its work follows the state's AB72 requirements.

Podiatry specialization

Podiatry is where DBS has its longest track record. It handles the rules that often trip up general billers at foot and ankle practices. Medicare limits coverage of routine foot care unless the patient has documented diabetes, peripheral vascular disease or another systemic condition. Orthotics and other DME fall under the same-and-similar restriction.

Foot and ankle surgeries carry global periods, and claims need the right Q7, Q8, Q9, GA and GY modifiers. DBS also follows the Local Coverage Determinations that apply in California. Beyond podiatry, the website lists mental health billing, and it names cardiology, neurology and orthopedics as departments.

How engagements work

Each new client starts with a review of its current workflow, claim volume, payer mix and recurring denials, so problems are found early. DBS then takes over daily submissions. It tracks claim status and payer requests, settles denials through corrections and appeals, and sends regular reports so the practice can see where its receivables stand.

Quotes are based on each practice's actual claim volume, and the company says it charges no hidden fees. It works from its San Francisco office and serves practices across the Bay Area, including Oakland, Berkeley, Daly City, South San Francisco and Marin County. It says it follows HIPAA requirements in all of its work.