Medical Billing Companies & Consultants in Duluth, GA

MedConverge is a revenue cycle management and practice consulting firm with an office in Johns Creek, Georgia, and a second location in Schaumburg, Illinois. It works with physician practices, ambulatory surgery centers and other providers, and is particularly focused on helping independent practices remain self-governing and financially healthy. The company says it has more than twenty years of experience in healthcare revenue work and that its staff together hold over a century of experience in the field.

Billing and Revenue Cycle Services

Its main offering is end-to-end management of a practice's revenue cycle, covering everything from enrolling with insurers to collecting balances owed by patients. Practices can hand over the whole financial workflow or pick individual parts of it. The core services include:

• Claims submission and medical billing aimed at fewer denials and faster payer turnaround
• Multispecialty, multi-facility coding by coders certified through AAPC and AHIMA
• Accounts receivable follow-up and clinical documentation support
• Credentialing and recredentialing with Medicare, Medicaid, PPOs, HMOs and MCOs
• Insurance eligibility checks and prior authorization handling
• Patient collections backed by a help desk and an online patient portal
• MACRA/MIPS and quality metrics reporting

Specialties Served

MedConverge reports billing experience in more than fifteen specialties. These include ambulatory surgery centers, cardiology, dermatology, emergency medicine, gastroenterology, infectious disease, nephrology, orthopedics, neurology, rheumatology, behavioral health, TMS therapy, ABA therapy, pediatrics and hospitalist groups. This range may suit multispecialty groups or practices in niche fields where coding rules are more complicated.

Consulting and Practice Management

The firm also offers advisory work beyond day-to-day billing. Its consultants assess practice profitability, audit coding, documentation and compliance, and review accounts receivable and global-period issues. For growing practices, it helps with new practice launches, negotiating payer contracts, marketing, SEO and websites, and provider training on compliance and documentation. For physicians planning to leave practice, it offers practice valuations, succession planning, support with mergers and acquisitions, advice on buy-sell agreements, and help with the transition after a sale.

Approach and Technology

MedConverge describes its model as combining trained staff with automation, using AI and robotic process automation in its billing and coding work. Clients get real-time analytics dashboards for tracking performance. The company also offers a web-based electronic medical records system with practice management features, as well as an ICD-10 coding assistance tool.

It works with PHOs, IPAs, clinically integrated networks and ACOs to strengthen clients' payer contracts, and it helps practices move from fee-for-service toward value-based care. Before taking on a practice, it can benchmark key revenue measures such as days in accounts receivable and adjusted collection rate, then propose a plan to bring weak areas up to industry norms.

Practolytics is a revenue cycle management (RCM) firm with an office in Duluth, Georgia, and another in Columbia, South Carolina. It works with healthcare providers of all sizes, from single clinics to groups with several locations. The company takes on the administrative work between a patient's appointment and final payment, so providers can spend less time chasing reimbursements. Its website describes it as an end-to-end partner for billing and related practice operations.

Core Billing and RCM Services

Medical billing is at the center of what Practolytics does. Its billing work includes checking insurance coverage, reviewing claims for errors before they go out, sending claims through a clearinghouse, recording payments, handling denials, and following up on unpaid accounts receivable. The company says it codes with ICD-10 and CPT standards and handles billing in a HIPAA-compliant way, adjusting to each insurer's rules. Its other services include:

• Eligibility and benefits verification
• Prior authorization requests: collecting documents, following up with insurers, and tracking approval status
• Provider credentialing
• Medical coding and compliance audits
• Virtual medical assistant support
• Practice consulting and payer contract negotiation
• Medical transcription and healthcare staffing

Specialties Served

The firm says each specialty has its own codes, payer rules and plan requirements, and it builds its billing approach around them. Some of its pages say it serves more than 40 specialties, while others say more than 28. Behavioral health is a major focus, with separate offerings for psychiatry, counseling and therapy, TMS, and Spravato billing.

It also lists urgent care, family and internal medicine, anesthesiology, cardiology, dermatology, oncology, orthopedics, gastroenterology, radiology, pain management, physical therapy, DME, wound care, fertility, many surgical specialties, and hospital inpatient billing.

How They Work With Clients

Practolytics offers prospective clients a free RCM audit and says it can deliver a custom quote within 24 hours. Its goals for clients are cleaner claims, faster fixes to denials, fewer days in accounts receivable, and steadier cash flow.

Its own published figures include a 98 percent claim approval rate, about 30 percent fewer AR days, and claims turned around within 48 hours. These are the company's own claims, not independently verified. Its services are pitched to both small practices and enterprise groups.

Background and Operations

The website gives conflicting details about the company's age. Some pages say it has been trusted since 2014, while the About page claims more than two decades of healthcare experience. Its stated mission is to be a single source for RCM services at competitive prices and to keep improving its service.

Its stated values are professionalism, integrity, trust and transparency, and commitment to service. The company says its facility has CCTV monitoring, its servers are restricted to authorized staff, and it uses several internet providers so it can meet its service-level agreements with clients. It also hosts a resource library with case studies, ebooks, white papers and blog posts for practices.