Primary Care: Preventive vs. Problem-Focused
Denials often stem from unclear documentation when preventive visits uncover new problems. We train on proper modifier use (-25, -33) and ensure diagnosis-code sequencing supports medical necessity.
Industries We Serve
From primary care to multi-specialty groups, NELSON LAZARO delivers billing precision tailored to your practice environment. We understand the unique payer rules, denial patterns, and coding requirements that define each specialty.
Specialized Billing Across Healthcare Settings
Our team brings deep domain expertise in the reimbursement landscape for each specialty. Every practice type has distinct challenges—and we've built workflows, KPIs, and denial-management protocols to address them.
Primary Care & Family Medicine
High-volume visits, diverse payer mix, preventive-care coding. We optimize E/M documentation, manage annual wellness visits, and ensure timely posting for commercial and Medicare Advantage plans.
Pediatrics
Well-child visits, immunization billing, and state Medicaid compliance. Our pediatric-focused team navigates age-based CPT codes, multi-vaccine bundles, and EPSDT requirements with precision.
Behavioral Health & Psychiatry
Specialized modifiers, telehealth parity, and add-on therapy codes. We track session-based billing, coordinate with EAPs, and stay current on evolving mental-health payer policies.
Physical Therapy & Rehabilitation
Unit-based billing, functional limitation reporting, and authorization management. We handle 8-minute rule calculations, appeal visit-limit denials, and optimize therapy plan documentation.
Diagnostic Imaging & Radiology
Technical vs. professional component splits, prior authorization tracking, and modifier discipline. Our imaging specialists ensure accurate charge capture for CT, MRI, ultrasound, and X-ray studies.
Laboratory & Pathology
Panel-code bundling, CLIA compliance, and LCD adherence. We manage high-volume test billing, track ABN documentation, and navigate complex lab fee schedules with surgical precision.
Multi-Specialty Groups
Unified reporting across disciplines with specialty-specific KPIs. We coordinate ancillary services, manage shared patient encounters, and provide consolidated analytics for enterprise decision-making.
Urgent Care
After-hours differentials, laceration repair, and fracture-care billing. Our urgent-care protocols ensure proper modifier use, timely claim submission, and rapid turnaround for cash-flow optimization.
Chiropractic & Wellness
CMT coding, maintenance-care documentation, and cash-plan coordination. We help chiropractors balance insurance reimbursement with membership models and ensure compliant billing for wellness services.
Payer Nuances & Denial Patterns by Specialty
Understanding the "why" behind denials is half the battle. Our team has mapped the most common rejection triggers for each practice type and engineered proactive workflows to prevent them.
Behavioral Health: Telehealth Parity
Reimbursement parity laws vary by state and payer. Our team tracks place-of-service code requirements, synchronous vs. asynchronous rules, and originating-site compliance to maximize telehealth revenue.
Physical Therapy: Visit Limits & Medical Necessity
Medicare and commercial plans impose strict visit caps. We proactively document functional improvements, manage exception requests, and appeal denials with evidence-based outcome data.
Imaging: Prior Authorization Compliance
Advanced imaging often requires pre-auth. We integrate authorization tracking into your workflow, follow up on pending requests, and escalate peer-to-peer reviews when initial denials occur.
Laboratory: LCD & ABN Enforcement
Local Coverage Determinations dictate when tests are covered. We maintain current LCD databases, flag non-covered scenarios, and ensure Advance Beneficiary Notices are obtained and properly filed.
Multi-Specialty: Cross-Discipline Coordination
Shared encounters require careful charge reconciliation. We prevent duplicate billing, coordinate ancillary-service coding, and provide specialty-level dashboards within a unified reporting framework.
KPIs Tailored to Your Specialty
Generic dashboards don't cut it in healthcare billing. Each specialty has unique performance drivers—and we surface the metrics that matter most to your bottom line.
Primary Care & Pediatrics
- Well-visit completion rate: Percentage of eligible patients receiving preventive services.
- Annual wellness visit capture: Medicare AWV utilization and billing accuracy.
- E/M level distribution: Ensuring appropriate code selection without under- or over-coding.
- Vaccine administration revenue: Accurate billing for multi-antigen administration and product supply.
Behavioral Health
- Session type mix: Individual, group, family therapy distribution and reimbursement variance.
- Telehealth parity tracking: In-person vs. virtual visit reimbursement comparison.
- Add-on code utilization: Psychotherapy with E/M, crisis intervention, and extended session billing.
- Payer-specific denial rates: Identification of high-friction payers for targeted appeals.
Physical Therapy & Imaging
- Unit-per-visit average: Therapy time documentation and 8-minute rule compliance.
- Authorization approval rate: Speed and success of prior-auth workflows.
- Technical/professional split accuracy: Ensuring correct component billing for radiology services.
- Claim submission velocity: Days from service to submission—critical for high-volume imaging centers.
Multi-Specialty Group Solutions
Large practices and health systems need more than siloed billing. Our enterprise approach unifies revenue cycle management across disciplines while preserving specialty-level visibility.
Consolidated Analytics Dashboard
A single executive view showing system-wide metrics alongside drill-down capability for each department. Track enterprise cash flow, payer performance, and denial trends—then pivot into specialty-specific detail when needed.
Shared Patient Encounter Management
When a patient sees multiple providers in one visit (e.g., primary care plus lab, or orthopedics plus imaging), we coordinate charge capture to prevent duplicate billing and ensure compliant claim submission.
Ancillary Service Coordination
In-house labs, imaging, infusion therapy, and DME require specialized coding and billing workflows. We integrate ancillary services into your master claim, track supply costs, and optimize reimbursement for bundled services.
Credentialing & Payer Enrollment
Adding new providers or opening new locations? Our credentialing team handles enrollment across all relevant payers, ensuring no revenue leakage during onboarding and expansion phases.
Specialty-Specific Reporting in Action
Every practice receives custom dashboards and monthly performance summaries tailored to their specialty's key metrics. Below is a sample view of the data insights we deliver.
Sample Report: Primary Care Practice
| Metric | Current Month | Prior Month | Change |
|---|---|---|---|
| Total Charges Submitted | $342,580 | $318,920 | +7.4% |
| First-Pass Acceptance Rate | 96.2% | 94.8% | +1.4% |
| Average Days in A/R | 28 days | 32 days | -4 days |
| Annual Wellness Visit Capture | 82% | 76% | +6% |
| Net Collection Rate | 97.1% | 96.4% | +0.7% |
Ready to See How We Serve Your Specialty?
Schedule a consultation to discuss your practice's unique billing challenges. We'll walk you through our specialty-specific workflows, sample reports, and performance benchmarks.