Physician Billing for Virginia Practices

We handle billing for solo independent physicians, single- and multi-specialty groups, IPAs and delegated medical groups, physician-owned surgical and procedural practices, hospital-affiliated faculty practice plans, office-based ambulatory physicians, telehealth physician groups, and locum or coverage physicians across Virginia — Virginia Beach, Norfolk, Richmond, Chesapeake, Alexandria, and the surrounding communities. New physicians joining an established Virginia group get credentialing, CAQH, and PECOS enrollment tracked from the offer letter forward, so the first claim is billable on day one rather than sitting in a holding queue. Groups billing across several sites of service get consistent POS handling so office, hospital-outpatient, and inpatient rates are never crossed; procedural practices get global-period tracking that separates bundled post-op care from genuinely billable visits; and locum or coverage physicians get the reassignment and Q6 handling that keeps temporary staffing from creating denied claims. Whatever the model, the aim is the same: every eligible encounter captured, coded to the level the record supports, and paid at the correct Virginia rate.

Virginia consolidated its Medicaid programs under the single Cardinal Care brand, and managed care runs through a set of contracted health plans — Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Molina Healthcare of Virginia, Sentara Community Plan, and UnitedHealthcare Community Plan. Because each plan carries its own network and prior-authorization rules, verifying the member's Cardinal Care plan and eligibility before the visit is the difference between a clean claim and an avoidable denial. On the Medicare side, Part B claims are adjudicated by Palmetto GBA, the contractor for Jurisdiction M, whose local coverage determinations and annual conversion-factor changes move the physician fee schedule from one year to the next.

Commercially, Anthem Blue Cross Blue Shield leads a competitive market alongside Sentara Health Plans, Aetna, Cigna, and UnitedHealthcare, and Hampton Roads adds a heavy TRICARE and military-family presence that few other states carry at the same scale. Between the anchor systems — Sentara Health across Hampton Roads, VCU Health and Bon Secours in Richmond, Inova in Northern Virginia, and UVA Health to the west — sit hundreds of independent single- and multi-specialty groups and IPAs that own their professional-fee revenue cycle outright. For those practices, collections are won on front-end discipline: confirming the Cardinal Care plan and enrollment, securing Medicare Advantage and commercial authorizations, and defending high-level established-patient E&M with a medical-decision-making or time note that stands on its own.

Across a commonwealth this varied — dense military markets, an academic capital, and high-cost Northern Virginia — preventable denials scale with volume, and one repeating error across a busy schedule quietly outweighs any single large write-off. These are the leaks we close first.