Medical Billing Companies & Consultants in Fairfax, VA

Acucare Health Strategies, Inc. is a Northern Virginia consulting and revenue cycle firm that works only with home health and hospice providers. The company has served agencies across the country since 1994. It describes itself as a center of excellence for consulting in this field, and it combines claims processing with coding, compliance and operations advice.

Buyers looking at medical billing vendors will find a narrow focus here: the firm works with agencies that bill Medicare and commercial payers for care delivered in the home, not with physician practices or hospitals in general.

Billing and Reimbursement Services

Acucare's billing work is handled by reimbursement analysts who process both Medicare and commercial claims. The firm aims to cut denials, rejections and additional documentation requests, and it works to bring days in accounts receivable under 30. Its claims workflow covers the whole revenue cycle, starting at patient admission and ending when payment reaches the agency's bank. Agencies can pick the type of engagement that suits them:

• Fully outsourced billing, where Acucare takes over hiring, training, claim submission and collections
• Billing and A/R cleanup on a per diem basis for backlogs of old or difficult unpaid claims
• Medicare Secondary Payer billing for services that the primary insurer does not cover
• Commercial billing, including eligibility checks, authorizations, claim submission and payment follow-up
• Revenue management and recovery of missed reimbursement

The billing arrangement is contingency-based. Acucare is paid only after a client's claims have been paid, and its fee is tied to revenue actually collected, not to the amount billed. Each engagement is set up around the agency's needs.

One client testimonial on the site, from a health system, credits the team with billing more than 2,700 claims in a 60-day holiday period while the client was moving to a new billing system. Some of those claims were up to a year old.

Coding, Compliance and Advisory Work

Besides billing, the firm offers diagnosis coding and OASIS review, chart audits, regulatory and clinical compliance support, operations and strategy consulting, and education and training. According to the company, its coders are registered nurses who hold HCS-D certification and are also certified OASIS instructors (COS-C), with more than 25 years of leadership experience.

Clients mention using the coding team to check their in-house coders' accuracy and to cover for staff who are absent. The site also publishes articles on wound care documentation, face-to-face encounter requirements and ICD-10 coding.

Approach and Background

Acucare says it starts each engagement by learning what the client needs and then builds a practical plan with measurable targets. It wants agencies to be able to carry out their own plans, not depend on the firm for everything.

Its stated mission is to act as a partner to providers and an advocate for patients, so that clinical staff can spend their time on care while the firm handles efficiency and compliance. It works with agencies of any size and in any location. Its office is in Fairfax, Virginia, and clients can use a secure online login portal.

Testimonials from small agencies say outsourcing billing to Acucare let them grow without adding billing staff or overhead.

CureCloudMed, Inc. is a Fairfax, Virginia company that handles medical billing, coding and provider credentialing for practices of every size, from a single physician up to larger multi-provider clinics. The firm says it bills for more than 100 providers in over 50 specialties, with clients in more than 30 states. Its goal is to take paperwork and revenue tasks away from the practice so clinicians can focus on patients. It also highlights its BBB accreditation and HIPAA-compliant workflows.

Billing, coding and revenue cycle

On the billing side, the team prepares and scrubs claims, sends them to payers and tracks each one through payment. When a claim is denied, it finds the cause, corrects it and resubmits. Certified coders assign CPT and ICD-10 codes and modifiers based on provider documentation, which the firm presents as a way to cut denials and lower audit risk.

Practices can also hand over the entire revenue cycle. In that case one team covers everything from scheduling to final collection and reports on collections, aging receivables and denial trends. Its service menus also list denial management, AR recovery and prior authorization.

Credentialing as a core strength

CureCloudMed calls credentialing and provider enrollment its lead service. The work includes:

• Building, attesting and maintaining CAQH ProView profiles
• Medicare and Medicaid enrollment via PECOS, plus revalidation
• Applications to commercial payer panels
• Registering NPIs in NPPES for newly added clinicians and sites
• Re-credentialing tracked to NCQA standards
• Weekly status updates on every open file

It runs dedicated programs for therapists and behavioral health clinicians, dentists and associate dentists, nurse practitioners and physician assistants, physical therapists, ABA providers, chiropractors and telehealth practices. For behavioral health, it sends applications to carve-out networks such as Optum, Evernorth, Carelon and Magellan. For NPs, it handles PCP panel requests, collaborative agreement requirements and incident-to setup. For dental offices, it reviews network leasing terms and Delta Dental participation tiers before contracts are signed.

Front office and practice support

The company also runs front desk administration. Staff answer calls under the practice's name, schedule and confirm visits, and check eligibility and benefits before each appointment. They also handle prior authorizations and referrals, follow up on missed appointments and collect patient balances at check-in. Value-added services include new practice start-up, tracking credential expiration dates, patient statements and payment posting. Dental billing is available for PPO, HMO and Medicaid plans.

Specialties and working model

Billers are grouped by specialty, so each account is handled by staff who know that field's codes and payer rules. Specialties served include cardiology, mental health, psychiatry, dermatology, orthopedics, pain management, radiology, gastroenterology, neurology, urology, pediatrics, OB/GYN, physical therapy, family practice, internal medicine, nephrology, podiatry, urgent care, dental and workers' compensation.

Clients do not have to switch software, because the team works inside more than 15 EMR and practice management systems, including Epic, NextGen, AdvancedMD, ICANotes and PrognoCIS. The firm also offers billing and credentialing from one team, which it says keeps payer enrollment and claims in step.

The Ashez Group LLC is a medical billing and revenue cycle management firm based in Fairfax, Virginia. It works remotely with healthcare organizations in all 50 states. Its clients include single-clinician offices, independent practices, specialty clinics and larger groups with several providers. The company takes on the administrative side of revenue work so that clinical staff can spend their time treating patients.

The firm covers the revenue cycle from the front desk through collections. A practice can hand over its whole billing function or hire the team for one task, such as clearing a backlog of aging receivables or enrolling a new clinician with insurers. Its main offerings are:

• Patient appointment scheduling and virtual front-office help
• Insurance eligibility and benefits verification
• Prior authorization and referral checks
• Charge entry, claim scrubbing and claim submission
• Payment posting
• Denial management and insurance A/R follow-up
• Provider credentialing, CAQH upkeep and payer enrollment
• Medical coding support
• Monthly reporting and practice audits

For eligibility checks, the team starts with electronic responses from payers and clearinghouses. When those automated replies leave gaps, staff review them by hand and contact the insurer directly. They confirm active dates, deductibles, copays, coinsurance, secondary coverage and referral rules, and note whether an authorization appears to be needed. The results are recorded inside the client's existing workflow.

After claims go out, the team tracks rejected, underpaid, unpaid and aging claims, looks for repeat denial patterns and payer problems, and then corrects and resubmits the claims.

Specialties and engagement model

The company lists experience in these areas:

• Behavioral health and psychiatry
• Primary care and internal medicine
• Cardiology and dermatology
• ABA therapy and physical therapy
• Pediatrics and OB-GYN
• Gastroenterology and urgent care
• Chiropractic and telemedicine
• Laboratories and organizations with several locations

New clients go through a set onboarding process. First, the team studies the payer list, past claims and receivables aging. Next, it sets up scrubbing rules, a clearinghouse connection and dashboards before going live. After launch, it holds monthly KPI reviews and analyzes the root causes of denials.

The firm says it can work within most major EHR and practice management platforms, so clients do not have to switch systems. Clients can choose a flat monthly fee or a percentage-of-collections arrangement, and there are no setup charges. Each account gets a dedicated team, a supervisor, and daily and weekly progress updates.

Prospective clients can request a free revenue analysis or consultation.

Credentials and background

The Ashez Group holds several diversity certifications. The SBA certifies it as a Women-Owned Small Business, and WBENC certifies it as a women's business enterprise. The Virginia Department of Small Business and Supplier Diversity recognizes it as a small, women- and minority-owned (SWaM) business. Its U.S.-based staff includes Certified Professional Coders and certified revenue cycle specialists.

They receive ongoing training on payer policy and on CPT and ICD-10 revisions, and they have worked directly in leading EHR systems and clearinghouses. The company says it follows HIPAA safeguards and CMS billing and coding guidance. It also reports working knowledge of Medicare, Medicaid, Blue Cross Blue Shield, Aetna, UnitedHealthcare and regional payers.