Get paid for every patient you see, from newborns to seniors. Billing built for Nevada family physicians who do it all.
Nevada Medical Billing provides full-service family medicine billing for solo family physicians, multi-provider groups, rural clinics, and FQHCs across Nevada. Our certified coders capture the full scope of family practice: well-child and VFC vaccine visits, adult chronic care, Medicare wellness, in-office procedures, and maternity care. We bill Medicare, Medicare Advantage, all five Nevada Medicaid managed care plans, and commercial insurers, so your collections match the care you deliver.
Free 90-day claims review. No contract required to see your results.
95%+
clean claims
96%+
net collection rate
<35
days in A/R
48hr
claims sent
5/5
Nevada Medicaid MCOs billed
Family medicine billing is harder because one practice bills the code sets of several specialties at once. In a single morning, a Nevada family physician may see a newborn on Medicaid, a teenager needing a sports physical, a pregnant patient, a diabetic adult on a commercial plan, and a Medicare senior due for a wellness visit. Each visit follows different codes, frequency limits, and payer rules.
Pediatric visits require VFC vaccine reporting and EPSDT components. Adult visits rely on chronic care and E/M complexity. Medicare seniors need AWV, care management, and risk adjustment. A biller who knows only one of these leaves money on the table in the others.
When a patient raises a new problem during a physical, both services can be billed, but only with correct modifier 25 use and separate documentation. Payers deny or bundle these claims more than almost any other family practice service.
Nevada has 952 active family physicians and needs 253 more to reach the national rate, according to the Nevada Health Authority's 2026 workforce assessment. Packed schedules leave staff no time to chase denials or work old A/R.
Since January 2026, Nevada Medicaid managed care covers every county, and rural members moved onto CareSource and SilverSummit. Family practices, which see many Medicaid children and families, now juggle up to five plans with separate credentialing and authorization rules.
Where Nevada family practices lose the most revenue:
Sick visits bundled into well visits without modifier 25
VFC vaccine administration billed with the wrong code or vaccine fee
Developmental and depression screenings performed but never coded
In-office procedures (I&D, skin tags, joint injections) missing from the claim
Global OB packages split incorrectly or billed before delivery
Claims sent to the old Medicaid plan after a member's MCO changed
Annual Wellness Visits and care management left unbilled for Medicare patients
If two or more of these sound familiar, your practice is likely losing revenue every month.
Your denial rate is above 5%. Most denials come from eligibility, coding, and modifier errors you can prevent.
A/R over 90 days keeps growing. Claims that age past payer filing limits become lost revenue.
Payments don't match your contracts. Underpayments go unnoticed without line-by-line posting against your fee schedule.
Your 99214 and 99215 levels look low. Undercoding complex visits costs more than most practices realize.
Medicaid claims bounce after plan changes. Members moving between Nevada MCOs cause wrong-payer denials.
One biller holds all the knowledge. When that person is out, billing stops.
You don't know your numbers. No monthly view of collection rate, A/R days, and denials means no way to fix them.
Not sure where you stand? Get a Free 90-Day Billing Audit and we'll show you the exact dollars at stake.
HIPAA compliant · Signed BAA · No obligation
Our family medicine billing services cover the full revenue cycle, from the appointment request to the final patient payment. Choose complete RCM or only the pieces you need.
We check active coverage, Medicaid MCO assignment, PCP assignment, copays, deductibles, and preventive visit limits before every appointment. *
We match your schedule to billed charges daily, so vaccines, screenings, labs, and procedures never fall off the claim.
CPC-certified coders assign CPT, ICD-10-CM, and HCPCS codes for pediatric, adult, geriatric, and maternity care. *
Claims pass payer-specific and NCCI edits before submission, usually within 24–48 hours of the visit.
We post ERAs and EOBs line by line and compare each payment to your contracted fee schedule. *
We appeal modifier 25 bundling, frequency, and medical necessity denials, then fix the cause so they don't repeat. *
We work aged claims by dollar value and timely filing deadline, including A/R left by a previous biller. *
We secure authorizations for imaging, specialty referrals, and medications across MA plans and Medicaid MCOs. *
We enroll family physicians, NPs, and PAs with Medicare, Nevada Medicaid, all five MCOs, and commercial plans. We also manage VFC program paperwork coordination and CAQH upkeep. *
We send clear statements, answer billing calls, and offer payment plans for family accounts. *
Monthly reports show collections, A/R days, denial rate, and revenue by provider, payer, and visit type. *
We compare payer payments to your contracts, flag underpaying plans, and give you the data to renegotiate rates with Nevada commercial payers.
We capture quality measures for preventive screenings, diabetes, and blood pressure control, so your practice avoids negative Medicare payment adjustments under the Quality Payment Program.
Our coders send short, practical feedback when notes don't support the level billed or a modifier. Your providers learn what payers need without extra training sessions.
Online payment links, text-to-pay statements, and payment plans help families pay balances faster without hurting your patient relationships.
We code the full scope of family medicine, so you don't need one biller for kids and another for Medicare. Below are the services family practices bill most often, grouped by patient stage.
| Service | Codes | What we get right |
|---|---|---|
| Newborn care | 99460–99463 | Hospital vs birthing center vs same-day discharge |
| Well-child visits | 99381–99385, 99391–99395 | Age bands and EPSDT components for Medicaid |
| Vaccine administration | 90460, 90461, 90471–90474 | Counseling vs non-counseling codes |
| VFC vaccines | Vaccine product code + admin | Vaccine reported at \$0; bill admin only |
| Developmental and behavioral screening | 96110, 96127 | Separate from the well visit |
| Sports and school physicals | Preventive or E/M codes | Coverage varies; patient responsibility explained upfront |
| Service | Codes | What we get right |
|---|---|---|
| Office visits | 99202–99215 | MDM or time support for each level |
| Complexity add-on | G2211 | Ongoing relationship, payer rules |
| Adult preventive exams | 99386–99387, 99396–99397 | Modifier 25 when a problem is addressed |
| Chronic Care Management | 99490, 99439, 99491 | Consent, care plan, monthly time |
| Behavioral health screening | 96127, G0444 | Depression and anxiety screens |
| Telehealth | POS 02/10, modifier 95 | Payer-specific rules |
| Service | Codes | What we get right |
|---|---|---|
| Welcome to Medicare (IPPE) | G0402 | First 12 months of Part B |
| Annual Wellness Visit | G0438, G0439 | Once per year; required elements |
| Advance Care Planning | 99497, 99498 | No cost share when billed with AWV |
| Advanced Primary Care Management | G0556–G0558 | Complexity tier |
| Transitional Care Management | 99495, 99496 | Contact and visit windows |
For deeper Medicare risk adjustment and hospital billing, see our internal medicine billing services page.
| Service | Codes | What we get right |
|---|---|---|
| Global obstetric care | 59400, 59510, 59610 | Bill after delivery; track antepartum visits |
| Partial antepartum care | 59425, 59426 | When the patient transfers care |
| Contraception | 58300 (IUD), 11981 (implant) + supply J-code | Device and insertion billed separately |
| Cervical cancer screening | Q0091, G0101 | Medicare-specific codes |
| Procedure | Codes | What we get right |
|---|---|---|
| Incision and drainage | 10060 | Modifier 25 with same-day E/M when separate |
| Skin tag removal | 11200 | Cosmetic vs medically necessary |
| Lesion destruction | 17110 | Lesion count |
| Joint injection | 20610 + drug J-code | Drug units and NDC for Medicaid |
| Laceration repair | 12001–12007 | Length and complexity |
| Ear wax removal | 69209, 69210 | Instrumentation vs irrigation |
| EKG, spirometry, CLIA-waived labs | 93000, 94010, modifier QW | Medical necessity linkage |
Codes reflect current CPT and HCPCS sets; we update our coding rules every January when new codes take effect.
Modifier 25 tells payers a separate, significant E/M service happened on the same day as a preventive visit or procedure. We apply it only when documentation supports a distinct problem, which protects you from both lost revenue and audit risk.
For preventive and wellness billing depth, see our primary care billing services page.
Whether you're a solo family physician or a 20-provider group, our billing scales with you.
| Practice type | What we handle for you |
|---|---|
| Solo family physicians | A full billing department without the payroll |
| Small and mid-size groups | Provider-level reporting and shared credentialing |
| Multi-location family practices | Location-level charge capture and payer setup |
| Rural Health Clinics (RHC) | All-inclusive rate billing and RHC claim rules |
| FQHCs and community health centers | PPS encounter billing and sliding fee schedules |
| Direct primary care and concierge practices | Membership billing plus insurance for covered services |
| Family medicine + urgent care hybrids | After-hours and walk-in coding |
| NP- and PA-led family clinics | Billing under each provider's NPI; Nevada grants NPs full practice authority |
| Telehealth-first family practices | Virtual visit place-of-service and modifier rules |
Settings we bill: office, telehealth, hospital newborn nursery, labor and delivery, nursing facility, and home visits.
We also support hospital-affiliated family medicine groups that need professional-fee billing separate from the hospital, and multispecialty groups with a family medicine department that needs its own coding rules and reporting.
No matter the setting, every practice gets the same dedicated account manager, certified coders, and monthly reporting.
| Payer category | Plans |
|---|---|
| Medicare | Noridian Healthcare Solutions (Jurisdiction E) |
| Medicare Advantage | Health Plan of Nevada/UnitedHealthcare, Humana, Aetna, Anthem, SCAN, Prominence, and others |
| Nevada Medicaid and CHIP | Fee-for-service Nevada Medicaid and Nevada Check Up |
| Nevada Medicaid managed care | Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan |
| Commercial | Anthem BCBS Nevada, UnitedHealthcare, Aetna, Cigna, Hometown Health, Prominence Health Plan |
| Marketplace | Nevada Health Link plans |
| Military | TRICARE |
Don't see your payer? We bill all major national and regional plans that serve Nevada patients.
Under Nevada's 2026–2030 Medicaid managed care contracts, CareSource and SilverSummit serve rural Nevada and all five plans serve Clark County. Because families often have members on different plans, we verify each patient's coverage individually at every visit.
We review 90 days of claims, denials, and A/R and show you the revenue you're missing.
We sign a BAA and connect to your EHR, clearinghouse, and payer portals.
We confirm every provider is active with Medicare, Medicaid, all five MCOs, and commercial plans.
We set up eligibility, charge capture, VFC, and OB tracking around your schedule.
Daily coding and claim submission begin.
We work your old claims in parallel so nothing expires.
KPI report and a call with your account manager.
These are the performance standards we manage your revenue cycle to, based on industry best practices for family medicine.
| KPI | What it measures | Industry best-practice target |
|---|---|---|
| First-pass clean claim rate | Claims paid without rework | 95% or higher |
| Net collection rate | Share of collectible dollars actually collected | 96% or higher |
| Days in A/R | Average time from visit to payment | Under 35 days |
| Denial rate | Claims denied on first submission | Under 5% |
| A/R over 90 days | Share of A/R older than 90 days | Under 15% |
| Claim submission | Time from visit to claim sent | Within 48 hours |
Your free audit compares your current numbers against these benchmarks, so you see exactly where revenue is slipping.
Well visits with a documented problem billed without the problem E/M and modifier 25
Vaccine administration billed with the wrong code set for the patient's age
Screenings (96110, 96127) performed but never coded
Medicare patients overdue for an Annual Wellness Visit
Denials left unappealed and claims close to timely filing limits
Payments below contracted rates from one or more commercial payers
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
| Cost | Salary, benefits, software, training | One fee tied to collections |
| Coverage of all ages | Often strong in one area only | Pediatric, adult, Medicare, and OB coders |
| Absences and turnover | Billing stops | Backup team keeps working |
| Nevada Medicaid MCOs | Five plans to learn | Already set up |
| Reporting | Manual spreadsheets | Monthly KPI dashboards |
| Growth | Hire more staff | Scales with your volume |
Full-service family medicine billing in Nevada typically costs 3–7% of monthly collections. Where your practice falls in that range depends on claim volume, number of providers, payer mix, and the services you choose. Practices with higher volume and cleaner workflows land at the lower end. There are no setup fees, the agreement is month-to-month with 30-day notice, and you get a fixed quote after your free audit.
"My cash flow will drop during the switch." We work your old A/R in parallel while new claims go out, so payments keep coming.
"I'll lose control of my billing." You get real-time access to every claim and a monthly review call.
"I'll have to change my EHR." No. We work inside the system you already use.
"Outsourced billers don't know Nevada." We bill Noridian, Nevada Medicaid, and all five MCOs every day.
"I'm locked in if it doesn't work." You're not. The agreement is month-to-month with 30-day notice. We earn your business every month.
eClinicalWorks, athenahealth, DrChrono, Tebra (Kareo), AdvancedMD, NextGen, Practice Fusion, Elation Health, Epic, and more. *
We sign a BAA before accessing any data, use encrypted role-based access, and follow CMS, AMA CPT, and OIG guidance. Regular internal coding audits keep you ready for payer reviews.
One team for every age: Pediatric, adult, Medicare, and maternity coding under one roof.
Nevada payer expertise: Noridian JE, Nevada Medicaid, all five MCOs, and local commercial plans.
Every setting covered: Office, telehealth, hospital, nursing facility, RHC, and FQHC.
Dedicated account manager: One person who knows your practice.
Full transparency: Real-time claim access and monthly reports.
One partner: Billing, coding, credentialing, prior auth, and virtual medical assistants.
Find out what your family practice is leaving on the table. Get My Free Billing Audit · Free 90-day review, no obligation.
HIPAA compliant · Signed BAA · No obligation
Las Vegas: Family practices across Summerlin, Spring Valley, and Enterprise with mixed Medicaid, MA, and commercial panels. *
Henderson: Growing family medicine groups serving young families and retirees. *
North Las Vegas: Family clinics with high pediatric, Medicaid MCO, and Nevada Check Up volume. *
Reno: Family physicians in Washoe County serving referrals from rural northern Nevada. *
Carson City: Family practices and clinics serving the capital and surrounding rural counties. *
We also serve Sparks, Elko, Pahrump, Mesquite, Fallon, Fernley, and other rural and frontier communities, including Rural Health Clinics.
Family medicine billing services manage the revenue cycle for family practices: eligibility checks, coding, claim submission, payment posting, denial appeals, A/R follow-up, credentialing, and patient billing. A good partner codes pediatric, adult, Medicare, and maternity care correctly.
Most companies charge a percentage of collections, commonly 3–7%. Your rate depends on volume, payer mix, and services. We give a fixed quote after a free audit.
Yes. Our coders bill well-child, VFC, and EPSDT visits as well as AWV, care management, and Medicare Advantage claims.
We report the VFC vaccine at no charge and bill only the administration code, following Nevada Medicaid and VFC rules.
Yes, when a separate problem is documented. We bill the preventive service and the problem E/M with modifier 25.
Yes. We track antepartum visits and bill the global package (59400 or 59510) after delivery, or partial codes when care transfers.
Yes. We handle RHC all-inclusive rate billing and FQHC PPS encounter billing in addition to standard fee-for-service claims.
Yes: Anthem, CareSource, Health Plan of Nevada, Molina, and SilverSummit, plus fee-for-service Medicaid and Nevada Check Up.
No. We work legacy A/R in parallel while new claims go out, and most practices go live in 2–4 weeks.
Yes. We work inside eClinicalWorks, athenahealth, DrChrono, Tebra, AdvancedMD, NextGen, and others.
Common signs include a denial rate above 5%, A/R over 90 days that keeps growing, payments below your contracted rates, and billing that stops when one staff member is out.
We focus on Nevada. We bill Noridian JE, Nevada Medicaid, and all five Medicaid MCOs every day, and our coders handle pediatric, adult, Medicare, and maternity care for family practices.
Yes. We capture quality measures during billing and track your MIPS performance to help you avoid Medicare payment cuts.
Yes. We compare payments to your contracted rates, flag underpayments, and provide data you can use to renegotiate with commercial payers.
Request a free billing audit. We review 90 days of your claims, show you the revenue at stake, and give you a fixed quote. If you move forward, onboarding takes 2–4 weeks.
You care for the whole family. Your billing should capture the whole visit. Nevada Medical Billing gives your practice certified all-ages coders, Nevada payer expertise, and a team that never stops following up.
Free 90-day review · No obligation · HIPAA compliant
Free 90-day review · No obligation · HIPAA compliant with signed BAA
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