Specialty Focus

Primary Care Billing & Coding

Primary care RCM: billing, coding, denials fixed by CPA experts. 8-12% net collections rise. Get your free primary care revenue audit.

$60/visit
typical E&M undercoding gap (99213→99214)
97%
clean-claim rate we target
14-day
TCM follow-up window tracked for you
10%+
net collections lift in the first cycle

Unique Billing Challenges

Primary care practices face some of the most complex billing environments in healthcare. With high patient volumes and a broad mix of services — from acute visits to chronic disease management — even small coding errors can compound into significant revenue loss.

Evaluation and Management (E&M) coding, updated under the 2021 AMA guidelines, requires careful documentation of medical decision-making (MDM) complexity. Many primary care practices still undercode visits out of audit anxiety, leaving thousands of dollars on the table each month. The difference between a 99213 and a 99214 can mean $40-60 per encounter — and across hundreds of daily visits, that gap grows fast.

Chronic Care Management (CCM) codes like 99490, 99439, and 99491 represent a major revenue opportunity that many practices fail to capture. These time-based codes require meticulous tracking of non-face-to-face care coordination, and without proper systems in place, billable time goes unrecorded. Similarly, Annual Wellness Visits (AWV) under G0438 and G0439 are frequently confused with standard preventive exams, leading to incorrect coding and lost revenue.

Transitional Care Management (TCM) codes 99495 and 99496 go unbilled at an alarming rate, despite offering some of the highest reimbursement in primary care. The strict 14-day follow-up window and required interactive contact within two business days of discharge create compliance hurdles that many practices struggle to clear without dedicated billing support.

How DeltaRCM Helps

DeltaRCM assigns certified coders with deep primary care experience to every account. Our team audits your E&M distribution to identify undercoding patterns and trains your providers on documentation that supports appropriate code levels — without increasing audit risk.

We implement structured CCM and TCM billing workflows so your practice captures every minute of billable care coordination. Our technology tracks patient eligibility, time logs, and follow-up windows automatically, so billable activity gets billed.

For preventive services, we maintain current payer-specific rules for AWVs, screenings, and immunization administration, ensuring correct modifier application and eliminating the patient balance surprises that damage trust and satisfaction.

Services for Primary Care Practices