Independent guidance on the services practices actually buy. The full provider directory sits behind every topic.
Paneling, payer enrollment, CAQH, timelines, vendor selection.
In-house vs outsource, pricing models, coding, payer contracts.
EHR selection by specialty, migration, practice-management software.
Consultants, MSOs, startup engagements, vetting and costs.
For new practice owners
You're opening or just opened a practice, and your biller keeps asking you things you don't understand yet. You don't need to become an expert overnight. Answer five quick questions and get a plain-English cheat-sheet — the few billing fundamentals that matter first, put in order for your situation.
Independent — GetPracticeHelp does not do your billing.
Start with one rule before anything else: get credentialed before you bill. Payers won't pay claims with a date of service before your enrollment is approved, and approval runs 90 to 120 days. After that, the short list is small — confirm patient insurance before the visit, send clean claims (no missing or wrong fields), and watch two numbers your biller can hand you: clean claims rate and AR days. You do not need to learn coding overnight to run the practice; you need to know which questions to ask and which numbers to check.
Clean claims rate is the share of claims that get accepted and paid the first time, with no rework. It is the single best health check on your billing. A strong practice sits around 95% or higher. If you only ask a biller or billing company one number, ask this one — a low clean claims rate means money is leaking into denials and rework before it ever reaches you.
AR days (days in accounts receivable) is how long, on average, your claims sit unpaid before money lands. Under 40 days is healthy; over 50 is a red flag that claims are stalling — denials, slow follow-up, or a payer problem. As a new owner you don't have to manage this day to day, but you should see it monthly. Rising AR days is usually the first sign something in billing broke.
It depends on volume and how much you want to learn. Doing it yourself is cheapest in dollars but costs hours and a real learning curve on denials, codes, and payer rules. An in-house biller gives you control but is a fixed salary cost. A billing company (or full revenue-cycle service) charges a percentage of what it collects — usually in the 4 to 8 percent range for behavioral health and 5 to 10 percent for most medical specialties — and takes the work off your plate. Many new owners outsource year one to avoid early mistakes, then revisit once they understand the workflow.
Almost always it is credentialing. Payers will not pay claims with a date of service before your enrollment effective date, and enrollment commonly takes 90 to 120 days from a complete application. Seeing patients does not start the clock — an approved payer enrollment does. The fix is to apply early (4 to 6 months before opening when you can), keep your CAQH profile current, and confirm each payer's effective date before you bill that payer.