Employed providers still have a professional claim to bill.
When a practice joins a health system, the facility side gets the attention and the professional side gets a queue. We work the professional billing to the system’s rules, with provider enrollment kept current so claims do not stall on a credentialing gap.
The professional claim, worked on its own clock
When a practice is employed by a health system, the facility side gets the attention and the professional claims age in a queue nobody owns. Enrollment under the system tax ID has to stay current or clean claims hold anyway.
Enroll the provider
Split facility and professional
Work the professional A/R
Enrollment lags the hire date
A provider sees patients before the payer enrollment lands under the system tax ID. Those claims hold, and the filing window runs while they do.
Provider based billing split incorrectly
The facility and professional components have to be split to the rule and the place of service. Coded loosely, one side bills and the other never does.
The professional queue waits behind the facility
Central billing works the large facility claims first. The employed practice’s professional claims age quietly in a queue nobody owns.
How the account runs for hospital owned practices
Here is what the work looks like, from the first review to the next action.
A defined task.
A documented action.
A visible next step.
Free 90 day audit
We read ninety days of your claims and tell you where revenue is stopping for hospital owned practices. If your billing is already healthy we will say so, and there is no charge either way.
A team that answers for the professional side
Somebody owns the professional claims specifically, so they are worked on their own clock rather than behind whatever the facility queue is doing.
Payer rules loaded
Your payer mix, their edits and their authorization requirements are set up before the first claim goes out.
Parallel run
We run alongside your current process for the first cycle so nothing is dropped in the handover.
Steady state and reporting
Monthly numbers at the right level of detail, and the aged A/R worked oldest first from day one.
Billed and worked for hospital owned practices
Agree the scope with your practice, then keep the day-to-day work organized around it.
- Professional billing for employed providers
- Provider enrollment and revalidation tracked
- Provider based and place of service rules
- Facility and professional split handled
- Coding to your compliance standard
- Denial management by reason code
- Aged professional A/R worked oldest first
- Monthly reporting per provider
The queue behind the facility
Central billing works the large facility claims first, so the employed practice’s professional claims wait. They are smaller individually and they add up to a number worth owning.
What changes when the whole cycle has one owner
None of this is a criticism of your staff. It is a question of what happens to the queue on a busy day.
| Situation | In the practice today | With iFocusRCM |
|---|---|---|
| A claim is returned | Reassigned to whoever picks it up | Reason coded, next action assigned the same day |
| A payer changes a rule | Found out by getting denied | Picked up in the edit set before submission |
| A balance starts to age | Statements go out when someone remembers | On a fixed statement and follow up cycle |
| One person is away | The queue waits for them | The queue does not know they were away |
| Two sites disagree | Argued at month end | One aging, one process, one report |
A few things to know before we start
The right scope starts with a clear conversation.
Ask it directly. You will get an answer from somebody who works accounts, not a sales script.
Monday to Friday, 8am to 5pm Central TimeOur facility billing stays in house. Is that a problem?
No, and it is the common arrangement. We take the professional side and work to the split your system already applies.
Who handles provider enrollment?
We track enrollment and revalidation under the system tax ID, because a lapsed enrollment stops claims that were otherwise clean.
Do you work inside our system’s software?
Yes. We log into the practice management or hospital system you already run. No migration and no new license.
We have compliance requirements from the system.
Send them during the audit. We code to your standard, and we would rather turn down work than agree to a standard we cannot hold.
An account of this shape uses the whole cycle. These are the pieces most often in it.
See what the professional side is leaving behind
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.