Medical Billing Companies & Consultants in Richmond, VA

Medical Management Solutions, Inc., known as MMSI, is a Richmond, Virginia company that takes over revenue cycle work for physician practices. It has been in business for more than two decades. It presents itself as an option for independent practices that want relief from growing administrative work while keeping control of their own operations. The firm works from an office on Monument Avenue in Richmond and also takes on practices in other parts of the country.

Practices and Specialties Served

MMSI works mainly with physician groups, and its client base spans many clinical fields. The specialties it names include:

• Mental health
• Family practice and pediatrics
• Internal medicine
• Ear, nose and throat
• Dermatology and orthopedics
• Pain management and plastic surgery

Billing and Revenue Services

The company covers the full claims workflow. It enters patient demographic data and charges, posts payments, sends claims electronically and follows up on outstanding receivables. Its staff review payer explanations of benefits to find problems and chase unpaid balances, including older accounts that have sat uncollected for a long time.

A dedicated denial management process aims to reduce how many claims are rejected and to get more of the rejected ones paid. MMSI also answers patients' billing questions for its clients. Separately, it offers credentialing as a stand-alone service, so a practice can use it without signing a billing contract.

Prospective clients can ask for a free collection analysis or a demonstration of the software.

How MMSI Works With Clients

MMSI builds each arrangement around the individual practice instead of selling standard packages. When a practice moves to its web-based billing system, the firm trains staff, on site if needed, and keeps supporting them until they are comfortable. This training is included at no added cost. The company says it uses checks to catch errors before claims go out. It also follows HIPAA requirements and handles client data securely.

Team and Credentials

The staff includes coders and billers with professional certifications. The company belongs to the AAPC, the MGMA and the AMBA. Mason Ayers is the owner and chief financial officer. He joined in 2015 and holds an MBA from Virginia Commonwealth University. Lois Ayers, who also arrived in 2015, leads marketing.

Tammy Schilke, a CPC and CPB, heads client relations and patient accounts and has been with the company for 13 years. Peggy Pernell runs the data entry and remittance processing team. Kara Houchins, with the firm since 2009, manages electronic data interchange. Angela Harding handles product support.

She brings more than 25 years in the industry, including time as administrator of a local internal medicine practice. For buyers, MMSI's main differences are its long local track record, a leadership team that has stayed in place for years, and a hands-on, customized service model.

RA Services, Inc. is a Richmond, Virginia firm offering revenue cycle management and related financial support to physician practices, hospital-based providers, hospitals and outpatient centers. The company has worked in healthcare billing for more than four decades. It runs its own practice management and coding software, a staffed patient call center and detailed reporting tools.

Its client testimonials come from a regional imaging director responsible for four imaging centers and from a solo physician, which shows that it serves both multi-site organizations and single-provider offices.

Core Billing and Revenue Cycle Services

The firm's full-service revenue cycle offering covers the path from charge capture through final collection. Highlights include:

• Coding software with built-in CCI and LCD edit checks plus QPP rules, aimed at cleaner first-pass claims
• Coding feedback to providers to support appropriate reimbursement
• Facility interfaces so hospital-based physicians receive patient demographics gathered elsewhere
• Electronic verification and entry of charges, along with posting of payments
• Persistent follow-up on rejected or outstanding claims, plus denial management guidance
• Checks confirming that payer remittances match negotiated contract rates
• Monthly accounts receivable performance reports and periodic reviews with an account manager
• A web portal where patients can pay by card at any hour

Coding, Audit, Compliance and Quality Programs

Beyond day-to-day billing, RA Services provides coding and compliance support for practices dealing with shifting regulations and insurer policies. Its audit group is made up of certified coders, CPAs and business managers.

The group reviews coding, billing and compliance either on site or remotely, then writes a work plan to fix problems that could lead to underpayment, nonpayment or compliance penalties. The company also tracks specialty-specific quality measures for MIPS reporting, offers Quality Payment Program consulting and provides financial management services when clients ask for them.

How the Firm Works With Clients and Patients

RA Services pairs automation with human judgment. Its staff, all based in the United States, examines each transaction before any adjustment is made to a billed account. The call center in Richmond is staffed by billing specialists who take calls from patients, insurers, attorneys and others with authorization.

The specialists can see account records, claim status, payment history and coverage details, which helps them resolve questions on the first call. They can also set up installment arrangements for patients with large out-of-pocket balances. Prospective clients can ask for a free practice assessment before signing on.

Leadership and Credentials

The leadership team brings long tenure and professional credentials. Mark Canada, the operations manager and compliance officer, holds a master's in health administration from VCU/Medical College of Virginia. Controller Tim Brown is a CPA with more than three decades of accounting experience. Joe Wyatt, the IT director and security officer, led development of the company's in-house billing and coding systems.

Billing manager Mike Kostyniuk, a CPC, has been with the firm for over 20 years. Rick Cassada, CPC, CMIS, manages both human resources and the coding team. Several leaders belong to the Radiology Business Management Association, and the company encourages staff to earn credentials in radiology, E&M and interventional radiology coding.

This points to particular depth in imaging and radiology billing.

Operating as both Revenue Cycle Management, LLC and Practice RCM, this Richmond-based company supports physician groups with claims processing, payment recovery and back-office administration. Seasoned executives from the medical sector run the business, and the firm states that it focuses exclusively on healthcare. Its customers include solo and small independent practices as well as sizable multi-physician organizations. Through alliances with partner companies, the firm says more than 1,200 practices can tap into outsourced operational services and purpose-built software.

Who They Serve

The company's client base falls into two broad groups. The first is office-based doctors who treat patients in their own clinics. For these groups, Practice RCM helps shape or improve the operational and financial strategy underpinning the practice, and it walks startups through launch tasks such as enrolling with insurers and mapping out daily procedures. The second is hospital-based physicians.

Here the firm creates methods for retrieving encounter and charge information from facility platforms, either by arranging data feeds with the hospital's technology staff or by logging into the facility's electronic chart system itself. Business offices within hospitals may also retain the company for supervisory and consulting assignments.

Billing and Revenue Services

Its receivables package combines practice management software hosted in the cloud, personnel who understand the client's field of medicine, and the materials required to handle the full billing process. The online systems it uses link with numerous electronic health record products, and proprietary claim-editing and charge-entry tools allow staff to monitor charges, claim transmissions and unpaid accounts. Primary offerings include:

• Handling of physician claims and follow-up on payments owed
• Provider credentialing and insurer enrollment, maintenance of CAQH records and oversight of PECOS filings
• Negotiation of insurer contracts and establishment of lockbox arrangements
• Examination, auditing and supervision of coding accuracy
• Deployment of EHR and practice software, along with connecting data between systems
• Financial and revenue reviews addressing coding, patient throughput and expense analysis
• Advisory work on running a practice, including preparation for adopting an EMR
• Financial planning support such as employee benefit administration and retirement strategies

How They Work With Clients

Advisory engagements usually open with a look at the practice's patient information, insurer composition, charge movement and coding patterns. The team then measures how well existing billing is performing, reviews outside vendor relationships, investigates rejected claims, analyzes insurer contracts and compares the amounts actually received with agreed reimbursement rates. Projects can be short-term or continuing. Prospective clients can request a free evaluation of their operations, and the company highlights teaching and staff training as central to how it works.

Team and Specialties

James Larsen, who leads revenue cycle operations as Director, has spent close to forty years in physician reimbursement. His background includes a five-year stint auditing Medicare claims in the field and a role in launching electronic claim submission at BCBS back in 1978.

He has worked with radiology and cancer radiation treatment practices, pathologists, foot and ankle specialists, mental health providers, internists and anesthesiologists. Erik Larsen, Director of Client Services, manages customer relationships and the intake side of data handling for the billing group.

Paula French, the Billing Manager, adds over three decades of claims work spanning a wide variety of platforms and insurers. The firm belongs to several professional associations, among them MGMA, a national body focused on running rheumatology practices, and a professional society for physicians who specialize in hospital care, affiliations that may interest prospective clients in those fields.