Medical billing & RCM since 2016

Get paid faster for every patient visit.

Optima Care Billing provides medical billing services for practices across the U.S., handling coding, claims, denials, and A/R follow-up so reimbursement arrives faster and your team gets back to patients.

Get a Free Billing Audit Estimate your revenue leak
  • HIPAA-compliant
  • Certified coders
  • 30+ specialties
  • Nationwide
Revenue overview
Sample practice · illustrative data
LIVE
Collected
$184.9k
▲ 8.2% vs. last mo.
Clean claims
96%
First-pass
Days in A/R
31
▼ 6 days

Works inside the EHR and PM systems your practice already uses

athenahealtheClinicalWorksNextGenTebraAdvancedMDDrChronoModMedEpicOracle HealthPractice FusionCareCloudOffice Ally
Revenue leak calculator

How much are unworked denials costing your practice?

Move the sliders to match your practice. The estimate updates as you go.

$150,000
12%

Share of submitted claims that come back denied.

40%

Denials that are written off or miss the appeal window.

Estimated revenue left on the table
$86,400

per year, based on your inputs

Denied each year$216,000
Never recovered$86,400
Recovered through rework$129,600
Get your real numbers in a free audit

This is a simple estimate from the numbers you enter, not a quote or a promise of results. A billing audit shows your practice's actual denial patterns.

Follow the claim

Revenue leaks at every step of a claim. We close each one.

Most lost revenue has nothing to do with the care you provided. Instead, it slips away at small steps along a claim's journey. Tap through each step to see where money leaks and how we stop it.

Step 01 · Before the visit

Confirm coverage before the patient walks in

Where it leaks

A plan changed in January and nobody caught it. The claim comes back, and then the visit becomes a collections problem.

What we do

We verify eligibility, benefits, and prior-auth needs ahead of scheduled visits and flag issues to your front desk.

Insurance eligibility verification
Medical billing services

Medical billing services that cover your whole revenue cycle

From the first eligibility check to the final patient statement, our medical billing services keep your revenue cycle moving, so payments arrive faster and with less manual follow-up.

Medical Billing

Charge entry, claim submission, payment posting, and patient statements, managed daily by a billing team that knows your payers.

Charge entryClaim submissionERA postingStatements
Explore medical billing about Medical Billing

Revenue Cycle Management

One partner accountable for the whole cycle: front-end checks, coding, claims, denials, A/R, and reporting that shows what's outstanding and why.

Front endMid-cycleBack endReporting
Explore RCM about Revenue Cycle Management

Medical Coding

CPT, ICD-10-CM, and HCPCS coding by certified professionals who keep up with annual code and payer policy changes.

Learn more about Medical Coding

Denial Management

We find out why claims get denied, fix the cause upstream, and then file corrected claims or appeals within payer deadlines.

Learn more about Denial Management

A/R Recovery

Structured follow-up on aging and stalled claims, including old balances your team hasn't had time to chase.

Learn more about A/R Recovery

Reporting & Analytics

Monthly reports on collections, denial trends, and A/R aging, plus a review call to walk through what the numbers mean for your practice.

Learn more about Reporting & Analytics

Patient Billing

Clear statements and a friendly team to answer patient billing questions, so your front desk isn't fielding balance calls all day.

Learn more about Patient Billing
2016

The year we started helping practices get paid accurately and on time

30+

Medical specialties we bill and code for

12

Revenue cycle services under one agreement

HIPAA

Compliant processes and a signed BAA with every client

Specialty billing

Built for the way your specialty gets paid

Every specialty has its own codes, modifiers, and payer rules. That's why our medical billing services are organized by specialty, so your billers and coders know what payers look for. Find yours below.

We didn't find that one in our list, but we probably still bill for it. Ask us about your specialty.

Showing 24 of 30+ specialties · See the full list

Why practices switch

Flip the switch and see the difference

In-house billing works until the one person who knows your payers is out sick. Toggle to compare a normal week.

Coverage

Depends on one or two people. Vacations and turnover stall claims. A full team of certified billers and coders. Work keeps moving.

At riskCovered

Denials

Worked when there's time, which often means after the appeal window. Worked daily, root causes fixed, and each one tracked to resolution.

At riskCovered

Code & payer updates

Training and research fall on staff who are already busy. Our team tracks annual code sets and payer policy changes for you.

At riskCovered

Visibility

Spreadsheets, guesswork, and surprises at month end. Monthly reports and a review call on collections, denials, and A/R.

At riskCovered

Cost

Salaries, benefits, software licenses, and the cost of turnover. One service agreement, no extra hires or billing software to manage.

At riskCovered
Compliance & security

Your patients' data, handled with the care it deserves

Because billing touches protected health information at every step, we treat HIPAA as the way we work, not a checkbox on a sales sheet.

Business Associate Agreement

We sign one with every client before we access any patient information.

Role-based access

Team members only see the data they need for the work assigned to them.

Encrypted file exchange

Documents and reports move through secure, encrypted channels, never plain email.

Ongoing HIPAA training

Every team member completes privacy and security training on a regular schedule.

Free billing audit

Find out where your revenue is getting stuck

Three quick steps, about a minute. After that, a billing expert will reach out to set up your audit. There's no cost and no obligation to switch.

  • Review of your denial reasons and trends
  • A/R aging breakdown by payer
  • Spot-check of coding against documentation
  • A short list of fixes, ranked by impact
(505) 472-4627 info@optimacarebilling.com Mon to Fri, 8 AM to 5 PM EST
Step 1 of 3
About your practice

What's your specialty?

Please pick the closest match.

How many providers?

Please choose a range.

Please don't include patient information. We'll only use your details to contact you about your audit.

Thanks, we've got your request

A billing expert will reach out within one business day to schedule your free audit.

Resources

Billing insights for practice owners and managers

View all resources
Client scenarios

What working with us looks like

Common situations we see in practices like yours, and how we handle them.

Client scenarios

Real problems, handled the same way every time

Each example follows the same path: find where revenue is stuck, fix the cause, and keep it fixed.

  • The challenge
  • What we did
  • What changed

These are illustrative examples based on common practice situations, not specific client results.

See what we'd find in yours

  • Cardiology group

    4 providers · in-house billing
    Illustrative scenario
    The challenge
    Echo and stress test claims kept coming back denied for missing authorizations, and professional and technical components were billed inconsistently between the office and the hospital.
    What we did
    Set up authorization checks before imaging visits, corrected 26/TC billing rules by location, and worked the open denials in order of appeal deadline.
    What changed
    Authorization gaps now get caught before the test instead of after the denial, and the front desk knows which visits need attention each morning.
    Cardiology billing

  • Behavioral health practice

    12 clinicians · adding new LPCs
    Illustrative scenario
    The challenge
    Newly hired counselors couldn't bill several payers yet, and some sessions were being billed with time codes that didn't match the documented session length.
    What we did
    Handled payer enrollment and CAQH for the new clinicians, reviewed time-based coding against notes, and began tracking authorizations and session limits.
    What changed
    New clinicians are enrolled and billing, and the team gets a heads-up before a patient reaches a session limit.
    Behavioral health billing

  • Urgent care center

    2 locations · high walk-in volume
    Illustrative scenario
    The challenge
    Claims piled up during busy seasons, and walk-in patients with outdated insurance led to a steady stream of eligibility denials.
    What we did
    Moved to daily claim submission, added same-day eligibility checks for walk-ins, and set up payer-specific rules for global versus itemized billing.
    What changed
    Claims keep going out daily even in peak season, and coverage problems are flagged while the patient is still at the counter.
    Urgent care billing

  • Orthopedic practice

    Switching billing companies
    Illustrative scenario
    The challenge
    The previous vendor left behind a large backlog of claims over 90 days old, and nobody could say how much of it was still collectible.
    What we did
    Ran an A/R cleanup project separate from day-to-day billing, prioritizing claims by value and timely-filing deadline, while onboarding new claims in parallel.
    What changed
    The practice has a clear picture of what's collectible, and old balances are being worked without slowing down current billing.
    Orthopedic billing

  • Family practice

    Solo physician · 1 front-desk staff
    Illustrative scenario
    The challenge
    The physician was catching up on billing at night, and vaccine administration codes were often missed when vaccines were given during sick visits.
    What we did
    Took over the full revenue cycle, set up vaccine product and administration billing together, and started a short monthly review call.
    What changed
    Evenings are no longer spent on claims, and preventive services and vaccines are billed consistently.
    Family practice billing

  • Independent laboratory

    High daily claim volume
    Illustrative scenario
    The challenge
    Tests were denied for medical necessity, and incomplete requisitions left claims stalled for weeks while someone tracked down missing details.
    What we did
    Added diagnosis checks against payer coverage policies, set up requisition follow-up with ordering offices, and monitored clearinghouse rejections daily.
    What changed
    Fewer claims sit waiting for missing information, and rejections are corrected and resent quickly.
    Laboratory billing
FAQ

Questions practices ask before switching

Don't see yours? Talk to a billing expert and get a straight answer.

A medical billing company handles the work between the patient visit and the payment: verifying coverage, coding the encounter, submitting claims, posting payments, working denials, and following up on unpaid balances. Our medical billing services cover all of this for your practice, and we report back on the results every month.

Most medical billing services charge a percentage of the collections they bring in, which ties the fee to your results. The right rate depends on your specialty, claim volume, and which services you need. We'll give you a clear quote after your free audit.

In most cases, no. Instead, our team works inside the EHR and PM systems practices already use, so your providers and front desk keep the workflow they know.

It depends on your system access, payer enrollments, and whether any credentialing needs updating. We onboard many practices within a few weeks, and we plan the transition so claims keep moving while it happens.

We sign a Business Associate Agreement before accessing any patient information, limit access by role, exchange files through encrypted channels, and train our team on HIPAA privacy and security requirements on an ongoing basis.

Read HHS guidance on business associates

We bill and code for more than 30 specialties, from cardiology and orthopedics to behavioral health, urgent care, and laboratories. If yours isn't listed, ask us, because there's a good chance we already work with practices like yours.

Let your team focus on patients. We'll handle the billing.

Book a free consultation and see what cleaner claims and steady follow-up from our medical billing services could look like for your practice.

Book a Free Consultation Talk to a Billing Expert