Full-service primary care medical billing and revenue cycle management for family medicine, internal medicine, and pediatric practices across Las Vegas, Henderson, Reno, and all of Nevada.
Nevada Medical Billing is a primary care billing company that helps PCPs get paid faster for every visit. We handle E/M coding, preventive and wellness claims, chronic care management, eligibility checks, prior authorizations, denial management, and A/R follow-up. That includes claims to Nevada Medicaid managed care plans, Medicare Advantage, and commercial payers. You focus on patients. We protect your revenue.
Free revenue analysis of your last 90 days of claims. No obligation.
Primary care runs on high visit volume and low-dollar claims. One missed modifier or expired eligibility check repeats across hundreds of visits a month. In Nevada, four extra pressures make clean billing even harder.
Nevada needs about 971 more primary care physicians to reach the national average, according to the Nevada Health Authority's 2026 workforce assessment. Clark County has only 60 primary care physicians per 100,000 residents. Fully booked schedules leave little staff time for claim follow-up, so revenue slips through the cracks.
Since January 1, 2026, Nevada Medicaid managed care covers every county. Urban Clark County patients can choose Anthem, CareSource, Health Plan of Nevada, Molina, or SilverSummit. Rural members are assigned to CareSource or SilverSummit. Each plan has its own credentialing, authorization rules, timely filing limits, and portal. A practice seeing Medicaid patients may now bill five plans instead of one.
About half of Nevada Medicare beneficiaries are in Medicare Advantage plans. MA plans pay based on documented risk (HCC coding and RAF scores) and add their own prior authorization rules. Weak diagnosis capture lowers your value-based payments.
Primary care coding changes every January. Recent additions include the G2211 complexity add-on and Advanced Primary Care Management (APCM) codes. Practices that code the way they did three years ago are leaving money on the table.
Preventive and problem-oriented visits billed together without modifier 25
Annual Wellness Visits never scheduled or billed for eligible Medicare patients
CCM and APCM time documented but never billed
G2211 missed on eligible Medicare visits
Claims sent to the wrong Medicaid MCO after a plan change
Timely filing denials from A/R that no one works past 60 days
HCC codes not carried forward each calendar year
We manage the full primary care revenue cycle, from the moment a patient books to the day the balance hits zero. Choose the complete package or only the modules you need.
We verify coverage 48–72 hours before each visit. That includes plan type, PCP assignment, copays, deductibles, and preventive benefit limits. For Medicaid patients, we confirm the current MCO, since plan changes are common after open enrollment. Eligibility Verification
Our certified coders assign accurate CPT, ICD-10-CM, and HCPCS codes for every encounter. We review documentation against current E/M guidelines (MDM or total time) and apply the right modifiers. Medical Coding
We reconcile your schedule against billed charges daily. Missed vaccines, in-office labs, EKGs, and care management time get captured before they're lost.
Every claim runs through payer-specific edits and NCCI checks before submission. We aim to submit clean claims within 24–48 hours of the visit through your clearinghouse.
We post ERAs and paper EOBs line by line, flag underpayments against your contracted rates, and reconcile deposits. Payment Posting
We work every denial, fix the root cause, and file appeals with supporting documentation. Monthly denial trend reports show which payers and codes cause the most trouble. Denial Management
Our team works aged claims by dollar value and timely filing risk, not just by date. Nothing sits past 90 days without action. AR Follow-Up
We handle authorizations for imaging, specialist referrals, and specialty medications. That includes MCO and Medicare Advantage requirements. Prior Authorization
We enroll new physicians, NPs, and PAs with Medicare, Nevada Medicaid, each MCO, and commercial plans. We also keep CAQH profiles and revalidations current. Credentialing Services
We send clear patient statements, answer billing calls, and set up payment plans that protect patient relationships. Patient Billing
You get monthly reports on collections, days in A/R, denial rate, clean claim rate, and payer mix. You'll always know where your revenue stands. Revenue Cycle Management
Primary care revenue depends on coding the full scope of what you already do. Our coders know which services pay, which payers cover them, and what documentation each one needs.
| Service | Codes | What we watch for |
|---|---|---|
| Office visits (E/M) | 99202–99205, 99211–99215 | Level selection by MDM or total time |
| Visit complexity add-on | G2211 | Medicare longitudinal care relationship; payer rules vary |
| Preventive medicine visits | 99381–99387, 99391–99397 | Age-based codes; modifier 25 when a problem is also addressed |
| Annual Wellness Visit | G0438, G0439 | Once-a-year frequency; required elements documented |
| Welcome to Medicare (IPPE) | G0402 | First 12 months of Part B only |
| Chronic Care Management | 99490, 99439, 99491, 99487, 99489 | Patient consent, care plan, monthly time thresholds |
| Advanced Primary Care Management | G0556, G0557, G0558 | Tier set by patient complexity; no time minimums |
| Principal Care Management | 99424–99427 | Single high-risk condition |
| Transitional Care Management | 99495, 99496 | Contact within 2 business days; face-to-face visit window |
| Behavioral Health Integration | 99484, 99492–99494 | General BHI vs Collaborative Care Model |
| Remote Patient Monitoring | 99453, 99454, 99457, 99458 | 16-day device data rule; interactive time |
| Advance Care Planning | 99497, 99498 | Can pair with AWV with no patient cost share |
| Prolonged services | 99417, G2212 | Commercial vs Medicare code selection |
| Immunizations | 90460–90461, 90471–90474 + vaccine codes | Counseling vs non-counseling admin codes; VFC billing |
| Screenings | G0444, 99406–99407, G0442/G0443 | Depression, tobacco cessation, alcohol screening |
| Telehealth visits | POS 02 / POS 10, modifier 95 | Payer-specific place of service and modifier rules |
Wrong modifiers drive many primary care denials. We apply modifier 25 for separately identifiable E/M services, 33 for ACA preventive services, 59 and X{EPSU} for distinct procedures, and 95 for telehealth where payers require it.
For Medicare Advantage and value-based contracts, we review charts for complete HCC capture under the CMS-HCC V28 model. We confirm that every chronic condition is documented with MEAT support (Monitor, Evaluate, Assess, Treat) and recaptured each calendar year. Accurate RAF scores mean fair payment for complex patients.
We code diabetes, hypertension, CKD, COPD, depression, and obesity to the highest supported specificity. That supports medical necessity, prevents denials, and feeds accurate risk scores.
We support independent PCPs, growing multi-location groups, and community clinics across Nevada.
Family medicine practices: All-ages care, from well-child visits and immunizations to geriatric chronic care.
Internal medicine practices: High-complexity E/M, chronic care management, and HCC-heavy Medicare Advantage panels.
Pediatric primary care: EPSDT well-child visits, VFC vaccine billing, and Nevada Check Up claims.
Geriatric and senior care practices: AWV, TCM, ACP, and Medicare Advantage risk adjustment.
Nurse practitioner-led clinics: Nevada grants NPs full practice authority, so we credential and bill NPs under their own NPI.
FQHCs and Rural Health Clinics: PPS and encounter-based billing, sliding fee schedules, and RHC-specific G-codes.
Direct primary care and concierge practices: Membership billing plus insurance claims for services outside the membership.
Multi-provider groups: Provider-level productivity reporting and centralized credentialing.
Providers we bill for: MDs, DOs, nurse practitioners (APRNs), physician assistants, and clinical staff whose services bill incident-to.
We know the claim rules, portals, and appeal paths for the payers your Nevada primary care patients carry.
| Payer category | Plans we bill |
|---|---|
| Medicare | Traditional Medicare Part B through Noridian (Jurisdiction E) |
| Medicare Advantage | Health Plan of Nevada/UnitedHealthcare, Humana, Aetna, Anthem, SCAN, Prominence, and other MA plans |
| Nevada Medicaid (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 and federal | TRICARE, VA Community Care |
Under the 2026–2030 Nevada Medicaid contracts, CareSource and SilverSummit serve rural Nevada. All five plans serve Clark County. We track which plan each patient belongs to, keep your providers credentialed with each one, and follow each MCO's prior authorization and timely filing rules.
Switching billing partners shouldn't disrupt your cash flow.
Free billing audit: We review 90 days of claims, denials, and A/R to find missed revenue and quick wins.
Onboarding and EHR access: We sign a BAA, connect securely to your EHR and clearinghouse, and map your payer mix.
Credentialing check: We confirm every provider is enrolled and active with each payer, including all Nevada Medicaid MCOs.
Front-end setup: We set up eligibility checks, prior authorization tracking, and charge capture workflows.
Daily coding and claim submission: Encounters are coded, scrubbed, and submitted within 24–48 hours.
Payment posting and denial work: ERAs are posted, denials are appealed, and root causes are fixed.
A/R cleanup: We work your legacy A/R in parallel so old claims don't expire.
Monthly performance review: You get a KPI report and a call with your dedicated account manager.
| KPI | Our target |
|---|---|
| First-pass clean claim rate | To be confirmed |
| Net collection rate | To be confirmed |
| Days in A/R | To be confirmed |
| Claim submission time | To be confirmed |
| Denial rate | To be confirmed |
| Factor | In-house billing team | Nevada Medical Billing |
|---|---|---|
| Cost | Salaries, benefits, software, training, turnover | One fee tied to collections |
| Coverage | Stops when staff are sick or quit | Backup team, no gaps |
| Coding expertise | Often one generalist biller | Certified primary care coders |
| Payer updates | Learned after denials appear | Tracked before they take effect |
| Nevada Medicaid MCOs | Five plans to learn | Already set up |
| Reporting | Manual spreadsheets | Monthly KPI dashboards |
| Scaling | Hire more staff | Scales with your patient volume |
We only earn when you get paid. Pricing depends on monthly claim volume, payer mix, and the services you choose. Request a free quote for a fixed price based on your numbers.
No software change needed. We bill inside the system you already use, including eClinicalWorks, athenahealth, DrChrono, Tebra (Kareo), AdvancedMD, NextGen, Practice Fusion, Epic, and Elation Health. EHR Integration · DrChrono Billing · eClinicalWorks Billing · Tebra/Kareo Billing
We sign a Business Associate Agreement before accessing any patient data. All work happens over encrypted connections with role-based access. Our coding follows CMS, AMA CPT, and OIG guidance. Regular internal coding audits keep your practice ready for payer and RADV reviews.
Nevada payer expertise: Medicaid MCOs, Noridian JE, and local commercial plans.
Primary care focus: Coders who know AWV, CCM, APCM, G2211, and HCC capture.
Dedicated account manager: One point of contact who knows your practice.
Full transparency: Real-time access to your claims and monthly reports.
One partner for everything: Billing, coding, credentialing, prior auth, and virtual medical assistants.
Find out how much revenue your practice is missing.
Get My Free Billing Audit →We serve primary care practices statewide, with deep experience in Nevada's largest healthcare markets.
Las Vegas: High-volume family and internal medicine practices with large Medicare Advantage and Medicaid MCO panels. Las Vegas
Henderson: Growing PCP groups and senior-focused practices that rely on AWV, CCM, and HCC accuracy. Henderson
North Las Vegas: Family and pediatric practices with heavy Medicaid and Nevada Check Up volume. North Las Vegas
Reno: Northern Nevada's regional hub, with patients from surrounding rural counties now on CareSource and SilverSummit. Reno
Carson City: Primary care clinics serving state employees and rural Northern Nevada. Carson City
We also support practices in Sparks, Summerlin, Elko, Pahrump, Mesquite, Fallon, and other rural and frontier communities.
Primary care billing services manage the revenue cycle for PCP practices. That covers eligibility checks, coding, claim submission, payment posting, denial management, A/R follow-up, and patient billing. The goal is to collect the full amount owed for every visit, faster.
Most billing companies charge a percentage of collections. The rate depends on claim volume, payer mix, and services included. We provide a fixed quote after a free review of your numbers.
Outsourcing usually costs less than a full in-house team once you count salaries, benefits, software, and turnover. It also adds certified coders and backup coverage. Practices with high denial rates or aging A/R often see the biggest gains.
Yes. We bill Nevada Medicaid fee-for-service and all five managed care plans: Anthem, CareSource, Health Plan of Nevada, Molina, and SilverSummit. We also handle credentialing with each plan.
Yes. We bill CCM, PCM, APCM, TCM, BHI, and RPM, and we help set up the consent and time tracking these codes require.
G2211 is a Medicare add-on code for office visits that are part of an ongoing primary care relationship. We apply it when documentation supports it and the payer recognizes it.
Yes. We work inside eClinicalWorks, athenahealth, DrChrono, Tebra, AdvancedMD, NextGen, and other major systems. You don't need to switch software.
We work your existing A/R in parallel so old claims don't expire.
Yes. We review documentation for complete HCC capture and MEAT support. This keeps RAF scores accurate for Medicare Advantage and value-based contracts.
Yes. We sign a BAA before onboarding, use encrypted access, and follow HIPAA privacy and security rules.
Yes. We credential and bill NPs and PAs, including NPs practicing independently under Nevada's full practice authority.
Stop losing revenue to denials, missed codes, and unworked A/R. Nevada Medical Billing gives your primary care practice certified coders, Nevada payer expertise, and full revenue cycle support.