Specialty Clinic Billing

Billing built for
your specialty.

Specialty practices face unique coding challenges general billers miss. We live in your specialty, from orthopedics to cardiology to dermatology.

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What's included

Specialty billing: full scope, no add-ons

Every engagement includes the complete scope below. No hidden tiers, no extra fees.

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Specialty-Specific Coding
ICD-10, CPT, and modifier expertise across orthopedics, cardiology, dermatology, gastroenterology, urology, and neurology, coded correctly the first time.
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Prior Authorization Management
We handle all prior auth requests, follow-ups, and appeals across every payer. Fewer delays, faster approvals, more procedures getting billed.
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Payer Contract Optimization
We audit your payer contracts and flag underpayments. Our team knows what each payer should be paying for each specialty code.
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Denial Prevention & Appeals
Specialty denials often hinge on documentation and modifier usage. We identify root causes and correct upstream processes to stop repeat denials.
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24-Hour Claim Submission
Claims go out within 24 hours of service with a 95%+ first-pass clean claim target, reducing days in AR and accelerating collections.
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HIPAA-Compliant Operations
HIPAA-compliant workflows with a signed BAA. All patient data encrypted at rest and in transit. Regular audits and staff training.
Why it matters

Why specialty billing fails when it's handled like primary care

Specialty practices get paid on procedures, modifiers, global periods and prior authorizations, and every one of those carries its own rules. A general biller who doesn't know that a global surgery period bundles post-op visits, or that cardiology echo billing splits into professional and technical components, will get paid less and denied more.

The numbers show the exposure. Experian Health State of Claims 2025 puts the initial denial rate at 11.8%, and specialty services with heavy authorization and modifier requirements sit above that. Orthopedics, cardiology, oncology and pain management regularly exceed 12% without specialty-specific front-end work.

Specialty knowledge changes the workflow, not just the coding. Authorization tracking by visit count, implant and drug billing, supervision rules for non-physician providers and payer-specific bundling edits all need someone who has seen them before.

We match your practice with billers and coders who work in your specialty every day, then run the full cycle from authorization through appeal.

How it works

How we onboard a specialty practice

  1. Week 1: Specialty and payer profileWe record your procedures, modifiers, global periods, top payers and authorization rules so the work starts with your specialty, not a generic template.
  2. Week 1 to 2: Baseline auditWe measure current denial rate, days in A/R, charge lag and the oldest unworked balances.
  3. Week 2 to 4: Go-live in your systemBilling work moves to us inside your existing EHR and practice management system, with no data migration.
  4. Ongoing: Authorizations, claims and denialsDaily authorization tracking, 24-hour claim submission and denial follow-up ranked by dollar value.
  5. Monthly: Specialty-level reportingDenial rate by payer and reason, modifier patterns, authorization performance and A/R by service line.
What to expect

What changes once specialty billing is handled properly

Practices usually notice the first change in the denial queue, not the bank account. Fewer same-day E/M denials, fewer modifier rejections, and authorization problems caught before the visit instead of after. Cash follows 30 to 60 days later, because claims that used to bounce now pay on first submission.

The second change is visibility. You see denial rate by payer, modifier use by provider and A/R by service line, which tells you where the next dollar is. Physicians usually care about one thing: the schedule stays full and the billing questions stop.

Specialty practices also need room to grow. You might add a provider, a site or a new procedure line. Because we work inside your systems and keep your rules documented, a new provider goes live with the same checks as everyone else.

Pricing

What specialty clinic billing costs

Full-service billing is priced as a percentage of collections: roughly 5% to 7% for solo and small practices, 3.5% to 5% for mid-size groups, and 2% to 3.5% for large groups. There are no setup fees, no minimum monthly charge and no long-term lock-in; you can leave with 30 days notice. The full breakdown is on our pricing page.

Specialty practices often fall in our mid-size tier, but rates depend on your specialty, collections and payer mix. We confirm the rate during the free revenue assessment, before you commit to anything.

FAQ

Questions we hear most

Which specialties do you bill for?

Orthopedics, cardiology, dermatology, gastroenterology, urology, neurology and many more. Our specialties page lists them, and each has a guide on the blog.

How do you handle prior authorization for specialty procedures?

We track every authorization by date and visit count, submit the clinical packet and follow up until there's a decision, then work denials with peer-to-peer support when needed.

Will you work inside our existing EHR?

Yes. We work in 40+ EHR and PM systems, so your clinical workflow doesn't change.

How do you prevent modifier denials?

We check modifiers against NCCI edits and payer policy and use them only when the documentation supports them. Modifier 25 and 59 are the usual trouble spots.

Related: All specialties · Denial management · Front-end access and prior authorization · Pricing.

See what your practice is leaving on the table.

Our free revenue audit identifies gaps in your specialty billing and shows exactly what Rcmaxis would recover, results in 5 business days, no obligation.

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