Family Medicine
AI-Powered Family Medicine Billing Services
Master family medicine billing with AI solutions specialized in E/M coding, chronic/preventive ICD-10 specificity, wellness visit guidelines, referral prior auths, and optimized primary care RCM workflows.
What Is Family Medicine Billing and Coding?
Family medicine billing and coding converts preventive wellness exams, acute illnesses, pediatric-to-geriatric chronic management (e.g., asthma, ADHD, vaccinations), and family referrals into clean, reimbursable claims.
Coders assign detailed ICD-10-CM codes for age-specific conditions (e.g., R05.9 cough, Z00.00 wellness), select E/M CPT codes (99202-99215) via MDM/time, and apply modifiers for split family visits per NCCI edits.
Billers verify mixed-payer coverage for vaccines/wellness, obtain prior auths for pediatric specialists/imaging, scrub claims for completeness, submit promptly, and resolve denials efficiently.
E/M Coding Across Age Groups
Family medicine E/M codes (99202-99215) demand tailored documentation for pediatric, adult, and geriatric MDM, time, or exam levels across diverse visits.
Impact: Frequent undercoding in mixed-family encounters
Chronic and Preventive Coding Variability
ICD-10 requires age-specific detail (e.g., J45.909 pediatric asthma, Z23 vaccinations), but multi-generational notes often lack specificity.
Impact: Eligibility denials and missed preventive reimbursements
Prior Authorizations for Pediatrics and Wellness
Vaccines, pediatric imaging (e.g., head CT), behavioral therapy, and specialist referrals need PA with growth charts or developmental milestones.
Impact: Delays in family care coordination and claim rejections
Our Expertise in Family Medicine Billing and Coding
Amy: AI Medical Coding Agent for Family Medicine Care
- Codes preventive wellness exams, acute pediatric visits, and multi-generational chronic care with precise E/M CPT (99202-99215), ICD-10 for asthma (J45.909), vaccinations (Z23), and age-specific conditions
- Applies MDM/time rules, well-child codes (99381-99397), and split-family modifiers
- Flags vague pediatric notes, preventive gaps, and undercoded complexity
- Audits diverse charts for documentation errors and HEDIS metrics
- Provides line-by-line rationale for compliance and transparency
Mark: AI Medical Billing Agent for Family Medicine Care
- Verifies eligibility across Medicare, Medicaid, commercial, and CHIP for wellness, vaccines, and family chronic management
- Validates E/M levels, age-specific diagnoses, and modifiers before submission
- Submits claims and handles charge entry in your EHR/billing system
- Reads ERAs and scans EOBs to post payments and detect underpayments
- Learns from family practice denial patterns like CO-16 eligibility issues
Adam: AI Denial Management Agent for Family Medicine Care
- Tracks claim status real-time for pediatric imaging, vaccines, and behavioral therapy referrals
- Makes AI-driven calls for prior auth disputes on developmental milestones and family wellness
- Uses customizable scripts for asthma management, pediatric specialist denials, and preventive rejections
- Manages outbound/inbound calls with full tracking
- Provides recordings, summaries, and recommendations to resolve aging family claims
What are the top denials in family medicine billing?
How does family practice coding differ from specialties?
What KPIs matter most for family medicine RCM?
How to optimize preventive visit billing?
Future-proof your Healthcare RCM with AI Workforce
Schedule a Call with Us to Discuss Your Needs
Email: info@combinehealth.ai
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