You're the doctor for the whole family, across a lifetime — well-child checks, sick visits, vaccines, chronic disease, Medicare wellness exams, sometimes all in one morning. That breadth is what makes family medicine invaluable. It's also why family practice carries one of the highest denial rates in primary care: 25% to 30%. And most of that loss is quiet — undercoded visits, missed same-day billing, mishandled vaccine claims — money slipping away across thousands of low-dollar encounters.
We capture all of it. Certified primary-care coders who bill every age, every visit type, and every payer correctly.
We review your E/M levels, your preventive-plus-problem billing, and your vaccine claims, and show you in writing what you're leaving on the table. No charge. No obligation. Yours to keep.
Family practice is the broadest billing challenge in medicine, and it's not close. In a single morning, one provider might complete a newborn well-child visit, treat a sinus infection, give a round of vaccines, manage a diabetic patient's medications, and walk an older patient through a Medicare wellness exam. Every one of those has different codes, different documentation rules, different payer requirements, and different patient cost-sharing.
That variety is exactly what makes you valuable to the families you serve — you're often the only doctor they see. It's also what makes the billing so easy to get wrong. And the losses rarely come from one big mistake. They come from small, repeated leaks across thousands of low-dollar visits: a complex visit coded a level too low, a same-day sick concern that never got billed alongside the well visit, a vaccine claim missing its administration code or modifier, a chronic-care service delivered but never billed.
None of it shows up as a dramatic denial. It just quietly never gets collected. Across a busy panel, that's tens of thousands of dollars a year — the difference between a practice that's squeezed and one that's healthy.
And your patients feel the edges of it too. When a preventive visit gets mis-coded into a surprise bill, that's a hard conversation with a family that trusts you. When billing runs clean, families get the care they came for without the billing confusion — and you get paid, correctly, for the work you already did.
Small errors repeat across a high-volume panel until they become a material annual loss.
The largest single leak. When a genuinely complex visit — multiple problems, a medication change, social factors complicating care — gets defaulted to 99213 instead of the 99214 or 99215 the documentation supports, the claim pays at the wrong level. No denial, no flag, just money left behind on visit after visit.
The signature family-practice leak. A parent brings a child in for a well visit and mentions an earache; an adult comes for a physical and asks about their blood pressure. When both a preventive service and a separate problem are addressed and documented, both are billable with modifier 25 — but collapse them into one code and you forfeit the problem visit entirely, on encounter after encounter.
Vaccines are one of the most common denial sources in family practice. Each needs the correct product code plus the right administration code — different for under-19 with counseling versus adults — plus modifier 25 on any same-day E/M, the correct Medicare G-codes, and administration-only billing for Vaccines for Children patients. Miss a piece and the claim denies or the revenue vanishes.
Chronic care management, transitional care after a discharge, behavioral health integration, advance care planning — all delivered routinely in family practice, all separately reimbursable, and all commonly left unbilled because the workflow was never set up to capture them.
Family practice has the most diverse payer mix in medicine — Medicare, Medicare Advantage, every state Medicaid, CHIP, TRICARE, commercial, and self-pay — and each processes preventive visits, vaccines, and wellness exams differently. Apply the wrong rule and the claim denies or the patient gets billed incorrectly.
When a covered preventive service is coded so it doesn't process at zero patient liability, the family gets a bill they shouldn't have — a trust problem in your waiting room and a collections headache for your front desk.
This add-on recognizes the ongoing, longitudinal responsibility that defines family medicine, and it's billable alongside your problem-oriented visits when that continuous care is documented. But it can't be paired with preventive services, and improper use draws denials and recoupment. Done right, it's added revenue on visits you already provide.
CMS formally recognizes social drivers like food insecurity, housing instability, and transportation barriers as factors that elevate medical decision-making. A hypertensive patient whose food insecurity complicates their medication adherence can support a higher-complexity visit — but only when that link is documented. Most practices leave this revenue on the table.
CMS raised physician payment modestly for 2026 but applied an efficiency adjustment that reduces reimbursement on many non-time-based procedural codes. Your margins now depend on capturing the full complexity of your cognitive work and every care-management service you deliver.
New and expanded codes let family physicians bill for care coordination and even caregiver training delivered without the patient present — real revenue for work most practices already do and never charge for.
Ten connected workflows protect every age, visit type, payer, preventive service, vaccine, and recurring-care opportunity.
We code every encounter on the medical decision-making or total time your documentation supports, capture the social factors that legitimately raise complexity, and keep you audit-safe on the high end too. Complex visits get paid as the 99214 or 99215 they are instead of defaulting to 99213 — recovering revenue most practices never realize they're losing.
Our charge workflow flags every wellness encounter for split-billing review, so when a patient raises a new or chronic problem during a scheduled physical or well-child visit, we bill both the preventive service and the separate problem-oriented E/M with modifier 25 correctly applied. On a busy panel, this alone recovers tens of thousands of dollars a year that most family practices don't know they're forfeiting.
We pair every vaccine product code with the correct administration code — the right one for under-19 with counseling versus adults — apply modifier 25 to the same-day E/M, use the proper Medicare G-codes, and bill Vaccines for Children patients as administration-only with the correct modifier. Vaccines stop being a denial source and become clean, reliable revenue.
Age-appropriate preventive codes for newborns through adults, Medicare Annual Wellness Visits with the required health risk assessment and prevention plan, developmental and behavioral screenings — each coded to the specific rules of the patient's age and plan, so nothing is missed and nothing is billed wrong.
We identify every patient eligible for chronic care management, set up transitional care management after discharges, and capture behavioral health integration and advance care planning — recurring, separately reimbursable revenue for coordination work your practice already performs for free.
We know each payer's quirks for preventive visits, vaccines, wellness exams, and same-day billing across Medicare fee-for-service and Advantage, every state Medicaid and CHIP, TRICARE, the major commercial carriers, regional plans, and self-pay — so the same service gets billed correctly no matter who's covering it.
We code covered preventive services so they process at zero patient liability the way they're supposed to, apply modifier 25 only when a truly separate problem is documented, and keep confusing, trust-damaging bills off your patients' statements.
We categorize every denial by payer, code, and reason, fix the root cause so it stops repeating, and appeal within the window — instead of writing off revenue the way overwhelmed in-house teams often have to.
We start enrollment at hire and monitor it across your full payer mix, so a new physician or advanced-practice provider isn't sitting unbillable while their schedule fills with patients.
E/M level distribution by provider, preventive-plus-problem capture, vaccine reimbursement, care-management revenue, net collection rate, denial rate by payer, A/R days — reported every month against your baseline, in plain language, with the leaks named.
If two or more of these are true, revenue is leaking — quietly.
We review E/M levels, preventive-plus-problem billing, vaccine claims, care-management capture, denials, and collections.
Family medicine's breadth is exactly where generic billers fail — they know a narrow set of codes, and they quietly miss the rest. We're built for the full range: peds well-child, adult preventive, geriatric wellness, vaccines, chronic care, and the widest payer mix in medicine, all in one system.
Correct E/M levels pay you for your thinking. Clean split-billing captures the work you actually did. Accurate preventive coding keeps surprise bills off your patients' statements. Doing the billing right serves the families across your exam tables, too.
G2211, social-driver documentation, the efficiency adjustment, expanded care-management codes — all wired into the workflow so you're never billing on outdated logic.
Provider-level E/M distribution, split-billing and vaccine capture, care-management revenue, net collection rate — reported monthly against your baseline. Month-to-month engagement, transparent pricing. If we're not improving your collections inside 90 days, you shouldn't stay.
Step 1 — Your free audit (5 minutes of your time). Tell us your practice size, age and payer mix, and biggest billing frustration. We confirm within one business day.
Step 2 — Your findings, in writing (5–7 business days). We audit a sample of your visits, your E/M distribution, your preventive-plus-problem and vaccine claims, and your care-management eligibility, then deliver a written report: where you're undercoding, what you're missing, and a dollar estimate of your annual leakage. Yours to keep.
Step 3 — We go live (5–10 business days). We work inside your existing EHR — no new system for your staff — configure coding and modifier logic, stand up the split-billing, vaccine, and care-management workflows, and take over your claims and denials. Your exam rooms and front desk keep running exactly as they do today.
Step 4 — Monthly performance you can actually read. Every metric that matters, tracked against your baseline, with a plain explanation of anything moving the wrong way and what we're doing about it.
Breadth. Family medicine bills for the entire age spectrum — newborn well-child visits through geriatric Medicare wellness exams — often in the same session, each with different codes, documentation rules, and payer requirements. Add the most diverse payer mix in medicine (Medicare, Medicare Advantage, every state Medicaid, CHIP, TRICARE, commercial, and self-pay), high volume, and lean administrative teams, and small errors compound into big losses fast. That's why family medicine carries one of the highest denial rates in primary care, commonly 25–30%.
When a patient comes in for a preventive visit — a physical or a well-child check — and also raises a new or chronic problem that requires separate evaluation, both services are billable: the preventive code plus a problem-oriented E/M with modifier 25. If your billing collapses them into a single preventive code, you forfeit the problem visit entirely. Across a practice doing hundreds of wellness visits a year, that's tens of thousands of dollars in reimbursement lost with no denial to signal it. We flag every wellness encounter for split-billing review so you're paid for all the work you did.
Every vaccine needs the correct product code paired with the right administration code — which differs for patients under 19 who receive counseling versus adults — plus modifier 25 on any same-day office visit, the proper Medicare G-codes for flu, pneumococcal, and Hep B, and administration-only billing for Vaccines for Children patients. Missing any piece is one of the most common family-practice denials. We code each vaccine claim clean so a major revenue stream stops leaking.
Very likely. Chronic care management pays your practice for the between-visit coordination you provide to Medicare patients with two or more chronic conditions, and most family practices bill little or none of it despite large eligible panels. Advance care planning, transitional care after discharges, and behavioral health integration are similarly under-billed. We identify eligible patients and set up the workflows to capture this recurring revenue every month.
By coding covered preventive services correctly so they process at zero patient liability, and applying modifier 25 only when a genuinely separate problem is documented. That means fewer denials for you and no confusing, trust-damaging bills for the families you care for — which matters when you're often the only doctor they see.
No. We work inside your existing EHR and workflow, so nothing changes about your exam rooms, your schedule, or your front desk. Most practices transition within two to three weeks with no gap in claim submission, and typically begin seeing improvement within 60 to 90 days.
You look after everyone — the newborn, the teenager, the working parent, the grandparent. Every dollar lost to an undercoded visit, a missed same-day problem, a mishandled vaccine, or an uncaptured care-management service is revenue you already earned caring for those families — it just never made it onto a clean claim.
PerfectMBS captures all of it, and protects your patients' trust while we do.
Free audit first. Written findings. A real dollar estimate. No obligation.Share a few details about your panel and payer mix. The written findings and dollar estimate are yours to keep.
