Family practice, also known as family medicine, is the cornerstone of healthcare — offering comprehensive and continuous care across all age groups, genders, and medical conditions. From routine checkups and chronic disease management to minor procedures and preventive screenings, family physicians play a critical role in primary care delivery.

But with such a broad scope of care comes complex billing requirements. At Progressive RCM, we understand the diverse needs of family practices and offer specialized billing solutions that ensure accurate claims, faster reimbursements, and improved compliance.

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What Makes Family Practice Billing Unique?

Family physicians often serve as the first point of contact for patients, making their services broad and varied. The complexity in billing comes from the variety of:

• Evaluation and Management (E/M) visits

• Wellness and preventive exams

• Chronic condition management

• Pediatric care

• Geriatric care

• Vaccinations and screenings

• Minor procedures

Each of these services requires precise CPT and ICD-10 coding, modifier use, and documentation to avoid underbilling or denied claims.

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Commonly Billed Family Practice Codes

Here are some of the frequently billed codes we manage for family medicine practices:

✅ E/M Codes:

• 99213–99215 – Established patient visits

• 99202–99205 – New patient visits

• 99381–99397 – Preventive visits (age-specific)

• 99406–99407 – Smoking cessation counseling

• 99495–99496 – Transitional care management (TCM)

✅ Chronic Care & Remote Monitoring:

• 99490 – Chronic care management

• 99457–99458 – Remote physiological monitoring

• 99441–99443 – Telehealth visits (audio-only)

• G0438–G0439 – Annual wellness visits (Medicare)

✅ Procedures & Vaccinations:

• 90471–90474 – Vaccine administration

• 11730–11732 – Nail removal

• 11300–11313 – Lesion removal

• 12001–13160 – Wound repair

• J codes – For injectable drugs and vaccines

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Challenges in Family Practice Billing

Family practices face some unique challenges in their billing cycle:

1. High Patient Volume

Family doctors often see 20–30 patients per day, making documentation and coding accuracy vital to keep cash flow steady.

2. Preventive vs. Problem Visits

When preventive visits (e.g., annual physicals) are combined with problem-oriented services, both must be coded and documented correctly to receive full reimbursement.

3. Vaccine and Injectable Billing

Billing for vaccines requires code pairing between the vaccine (e.g., J07BX03) and the administration code (e.g., 90471), plus any applicable VFC modifiers.

4. Payer Variability

Medicare, Medicaid, and commercial insurers all have different rules regarding preventive services, telehealth, and chronic care reimbursement.

5. Documentation Requirements

E/M coding is now based largely on time and medical decision-making (MDM). Lack of clear documentation can lead to downcoding or denials.

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Our Family Practice Billing Services

At Progressive RCM, we provide complete family practice billing services — from verifying eligibility to final reimbursement. Our goal is to make billing seamless, compliant, and profitable.

✅ Insurance Eligibility & Authorization

• Real-time insurance verification

• Identify coverage gaps, co-pays, deductibles

• Manage prior authorizations for imaging, DME, referrals

✅ Coding & Charge Entry

• Accurate CPT, ICD-10, HCPCS coding

• Apply proper modifiers (25, 59, 26, etc.)

• Distinguish between preventive and sick visits

✅ Claims Submission & Scrubbing

• Clean claim submission within 24–48 hours

• Use of claim scrubbers to detect errors

• Payer-specific formatting for faster acceptance

✅ Denial Management & Appeals

• Identify the root cause of denials

• Fix incorrect coding, documentation, or eligibility issues

• Submit timely appeals with clinical support

✅ Payment Posting & Reconciliation

• Auto-posting of EOBs and ERAs

• Identify underpayments or short pays

• AR follow-up on claims over 30 days

✅ Patient Billing & Support

• Clear patient statements with online payment options

• Handle billing inquiries professionally

• Offer payment plans for out-of-pocket costs

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Software & Systems We Work With

We integrate seamlessly with:

• AthenaHealth

• AdvancedMD

• Kareo

• eClinicalWorks

• NextGen

• DrChrono

• Practice Fusion

No matter what EMR or PM system you use, we optimize it to your practice’s billing needs.

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Why Choose Progressive RCM for Family Practice Billing?

✅ Primary Care Billing Experts
We understand family medicine workflows and clinical documentation.

✅ E/M & Preventive Coding Accuracy
We code problem-focused and preventive visits on the same day — maximizing revenue.

✅ Chronic Care Revenue Programs
We help you bill for CCM, TCM, RPM, and other CMS-approved programs.

✅ Affordable and Scalable
Our services fit solo, group, and multi-location practices.

✅ Monthly Reporting and Analytics
Get reports on productivity, payer performance, AR trends, and denial causes.

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KPIs We Track to Grow Your Practice

• Clean claim rate

• First-pass resolution rate

• Denial rate by payer

• Days in AR

• Average reimbursement per visit

• Patient collections

• Preventive vs. sick visit revenue

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Final Thoughts

Family medicine covers a wide range of services — and billing for them requires attention to detail, coding knowledge, and compliance awareness. Whether you’re running a solo practice or a multi-provider clinic, Progressive RCM ensures that your billing processes are smooth, accurate, and profitable.