Billing Clean-Up Services for New Practices

Billing clean-up services for new practices

Billing clean-up services for new practices fix a first year of billing that went wrong while the practice was being built: visits before enrollment was effective, claims parked on hold with no owner, a practice management system set up with the wrong NPIs or place of service, payers that were never contracted.

Tell us when you opened and which payers you bill. No patient data needed.

We inventory everything unbilled and unpaid, recover what the payer rules still allow, write off the rest with a reason your accountant can read, and rebuild the setup so year two does not repeat year one.

This sits above the day-to-day claim work. Buy it on its own or pair it with our other billing services, stage by stage.

Last reviewed October 21, 2026 by the Remitwright billing team. Editorial policy

What billing clean-up for new practices covers

Enrollment audit for every provider against NPPES, PECOS, the state Medicaid file and each contracted plan, with the real effective date recorded

Held claims released where the payer will pay, billed to the patient where the rules allow, or written off with a stated reason

Unbilled visits triaged by filing limit: Medicare's one calendar year from the date of service and Medicaid's 12-month federal outer limit first, then each commercial contract

Setup corrected in your PM system and clearinghouse: individual and group NPIs, taxonomy, tax ID, place of service, billing versus rendering provider, EDI and ERA enrollment

Fee schedule built from your actual contracts, not a template copied from another practice

Posting caught up from the 835s and paper EOBs, and patient balances corrected before any statement goes out

First-year denials logged by CARC and RARC and routed: corrected claim, appeal, or write-off with reason

Credentialing calendar started: Medicare revalidation every five years (three for DMEPOS), Medicaid on the state's cycle, CAQH re-attestation and license expirables

Medicare reporting duties set up: ownership, adverse legal action and practice location changes within 30 days, other changes within 90

What goes wrong when billing clean-up for new practices is skipped

Seeing patients before the effective date

Two physicians open on February 1 and file their Medicare applications in March. The effective date is the later of the filing date and the date they began furnishing services at the location (42 CFR 424.520), and 42 CFR 424.521 allows billing back only 30 days before it, and only when circumstances prevented enrolling in advance. Most of February's Medicare visits can never be billed to Medicare.

The system built from somebody else's template

The vendor loads a demo configuration: no group NPI, the owner as rendering provider on every claim, the wrong place of service for the setting. The clearinghouse rejects claims for weeks, the 277 acknowledgments go to an inbox nobody reads, and the practice believes it has billed when nothing has reached a payer.

Held for credentialing, then forgotten

Claims for a new payer are held until the contract is effective. The date arrives, nobody owns the release, and the payer's filing window closes on claims that were clean, authorized and fully payable.

How we run billing clean-up for new practices

Inventory

Every visit since opening matched to a claim, a payment, a hold or nothing, and every provider to an effective date per payer: a dated list of what is recoverable.

Recover

Claims inside a filing window go out oldest first, held claims are released against effective dates, and denials are worked by route.

Correct the setup

NPIs, taxonomy, place of service, fee schedule, EDI and ERA enrollment and hold rules fixed so the next claim is clean.

Write off with reasons

Balances the rules no longer allow, listed by payer and reason for your approval, with the reasons kept on the account for any later audit.

Hand over

The clean-up report and the corrected setup checklist, with your dedicated biller carrying on under ongoing medical billing.

What you receive every week

Clean-up inventory report

What was found, recovered by payer and written off with why, and what remains open with its deadline.

Corrected setup checklist

Every payer with its NPI mapping, EDI and ERA status, fee schedule source and hold rule, signed off as fixed.

Enrollment tracker

Each provider against each payer: status, effective date, revalidation dates and the next action.

Weekly report

Claims out, paid, denied and held, the inventory still open, and the write-offs awaiting your approval.

Worked example: a family practice eight months after opening

A hypothetical two-physician family practice opened on February 1 and asks for help in October. Its Medicare applications were filed on March 10, so visits from February 8 fall inside the 30-day retrospective window and are billed, on the basis that circumstances prevented earlier enrollment; visits from February 1 to 7 are written off with the reason recorded. Medicaid enrollment was never filed: it goes in now, and the Medicaid visits are held with their 12-month deadlines logged. A commercial contract became effective in June but its hold was never lifted, so those claims are released. The weekly report starts with the clean-up.

Questions about billing clean-up for new practices

How do we know if our new practice needs a billing clean-up?

Common signs: cash that does not match visit volume, a hold queue nobody can explain, clearinghouse rejections nobody is reading, a provider whose claims all deny for enrollment, and patients who have never had a statement. If two of those are true, the inventory is worth doing.

Can we still bill for visits before our Medicare enrollment was approved?

Only within a narrow window. Physicians and practitioners may bill up to 30 days before the effective date when circumstances prevented enrolling in advance, or 90 days in a Presidentially declared disaster (42 CFR 424.521). The effective date is the later of the filing date of the approved application and the date services began at the location (42 CFR 424.520). Anything earlier cannot be billed to Medicare.

How far back can you bill old claims?

Medicare claims must be filed no later than the close of the period ending one calendar year after the date of service, with narrow exceptions (42 CFR 424.44). Federal rule requires states to make Medicaid providers submit claims within 12 months of the date of service, and states and plans can set shorter limits (42 CFR 447.45). Commercial limits are in your contract.

Do you take over our existing system or move us to a new one?

We work in the system you have. Tebra, DrChrono, Practice Fusion, SimplePractice and AdvancedMD, with Office Ally, Claim.MD or Availity, can all be set up correctly; a migration is raised only if the system itself is the problem.

What gets written off and who decides?

You decide. The list is by payer and reason: outside the filing limit, before the enrollment effective date with no retrospective allowance, or a payer the practice never contracted where the patient cannot be billed. Nothing leaves the ledger without your approval.

How long does a clean-up take?

It depends on how many months of visits are involved and how many payers are missing enrollment. After the inventory you get a dated plan with the recoverable claims ordered by deadline. We do not quote a duration before we have seen the data.

Can a billing clean-up be done remotely?

Yes. The clean-up biller works in the practice management system and clearinghouse you already have, under a BAA, and rebuilds the fee schedule, the payer enrollments and the open claims from there. Paper EOBs are scanned by your front desk into the system you own; nothing is mailed to us. Remote medical billing explains the access model.