AMS Solutions provides outsourced medical billing services for hospitals, clinics and physician practices nationwide: charge entry, claim submission, payment posting, denial management, A/R follow-up and reporting, handled by a dedicated team with AAPC-certified coders, under a signed business associate agreement, for a transparent percentage of collections. Physician-founded in 1992.
Outsourcing medical billing means handing the back end of your revenue cycle, from the moment an encounter is documented to the moment the balance reaches zero, to a company whose only job is collecting it. Your practice keeps scheduling, registration, charge capture and clinical documentation. We take the claim from there and report on it in the terms the industry uses to measure billing.
What is included
Every AMS outsourced billing engagement covers the full back end of the cycle, in your existing EHR and practice management system:
- Demographic and charge entry, with the quality checks that stop rejections before they happen.
- Claim scrubbing and submission to every payer, electronic wherever the payer supports it.
- Payment posting and bank-deposit verification, so every remittance is posted and every dollar is confirmed in your account.
- Denial management: root-cause identification, correction, appeal, and tracking by payer and reason so the same denial is not worked twice.
- Accounts receivable follow-up on every open balance, insurance and patient, on a schedule set by payer and age.
- Secondary and patient billing, including statement cycles.
- Reporting on collections, denial rates, A/R aging and payer-level trends, with each metric defined in writing. HFMA’s MAP Keys, such as Clean Claim Rate (CL-1), Remittance Denial Rate (AR-5), Aged A/R as a Percentage of Total Billed A/R (AR-1) and Net Days in A/R (FM-1), give you published definitions to compare against.
- A dedicated account representative who knows your practice, your payers and your providers.
The scope above is the same scope described on our medical billing services page; this page explains how it works when the whole function moves to us.
What stays in-house
Outsourcing does not remove the practice from its own revenue cycle. Four things remain yours, and they decide how clean our claims can be:
- Scheduling and registration, including collecting accurate demographics and insurance at every visit.
- Check-in and the January re-check. Your front desk collects the insurance card and copay at every visit and re-verifies coverage at the January plan change. Eligibility verification itself is part of our scope when it is contracted for; we build the workflow with your front desk and flag the failures.
- Charge capture and provider documentation. We code from what is documented and query providers when the record does not support the charge. We do not bill what is not there.
- Clinical and financial policy decisions: fee schedules, write-off approvals, patient financial-hardship policies.
The line between your work and ours is written into the agreement.
The 90-day transition at a glance
| Days | What happens | Who owns it |
|---|---|---|
| Before day 1 | Cutover date set for dates of service; ownership of legacy A/R decided | Practice and AMS, in the contract |
| 1 to 30 | Business associate agreement signed before any PHI is shared (45 CFR 164.504(e)); named-user access to EHR, clearinghouse and payer portals; Medicare EDI authorization notice filed with the MAC (CMS, EDI System Access and Privacy, updated 10 September 2024); fee schedules loaded; baseline MAP Keys pulled | AMS drives; practice signs and provides access |
| 31 to 60 | First claims out from the cutover date; daily clearinghouse acceptance review; weekly call on rejections and denials; legacy A/R worked in parallel | AMS |
| 61 to 90 | Post-cutover CL-1, AR-5 and charge lag compared with baseline; statement cycle confirmed; legacy A/R closed out or transferred; any held provider enrollments resolved | AMS reports; practice reviews |
The short version: month one is paperwork, month two is the cutover, month three is measurement.
Billing and credentialing under one roof
When billing moves to an outside company, the riskiest hand-off is between whoever manages enrollment and whoever sends the claims. A new provider’s first claims, a pending payer application, a Medicare revalidation coming due (Medicare requires enrollment to be revalidated every five years under 42 CFR 424.515): each is a date the billing team has to know about before it submits.
At AMS those dates sit with the same team that bills. We file and track Medicare (PECOS), Medicaid (in Texas, through TMHP) and commercial applications, keep CAQH profiles current, and hold a provider’s claims until the payer confirms enrollment. You deal with one company, not two that have to reconcile what the other knew.
Full detail on scope, timelines and Texas-specific rules is on our medical credentialing services page.
Pricing: a transparent percentage of collections
AMS charges a percentage of collections. The percentage, and the definition of “collections” it applies to, are set out in writing before you sign, so the fee moves with your revenue.
Two things are worth knowing about how that fee interacts with Medicare. First, Medicare will pay a billing agent directly only if the agent’s compensation is not tied to amounts billed or collected; those conditions do not apply when the agent prepares the claims and does not receive and negotiate the payments (42 CFR 424.73(b)(3); Medicare Claims Processing Manual, Chapter 1, §30.2.4). All payer remittances are deposited to your practice’s account; our access is posting and reconciliation. Second, because our fee is tied to what is collected rather than what is billed, our interest and yours are the same: a claim that pays.
Your quote depends on specialty, volume, payer mix and scope. Ask for it in writing and compare it line by line with any other proposal.
Who it is for
AMS, physician-founded in 1992, serves hospitals, clinics and physician practices nationwide. Practices that benefit most from outsourced billing tend to share a profile:
- Independent practices whose billing depends on one or two people, so a resignation or long leave puts claims at risk.
- Multi-location groups whose front-end discipline has outgrown a single billing office.
- Specialty practices (cardiology, neurology, OB/GYN, oncology, orthopaedics, mental health and others) whose payer rules punish generalist billing.
- Hospital-affiliated clinics that need professional-fee billing separated cleanly from facility billing.
- Practices adding providers, where credentialing and first claims need to be handled by the same team.
Results from three AMS clients, each with a different specialty and starting point, are published in our case studies: a Michigan internal-medicine practice that reduced its accounts receivable, a three-location neurology and sleep practice that reached a 98.9 percent first-pass clean-claim rate, and a family practice that increased collections per visit by 46 percent. Each result reflects that practice’s circumstances; the case studies explain how each was measured.
Frequently asked questions
How long does it take to outsource medical billing?
Plan on 90 days from signature to a stable state: about 30 days of contracting, access and enrollment paperwork, 30 days of go-live with legacy A/R worked in parallel, and 30 days of measurement against the baseline. The first Medicare deposits from the new setup typically arrive in the second month, because Medicare’s payment floor for electronic claims is the 14th day after receipt.
Do we have to change our EHR or practice management system?
No. AMS works inside the systems you already use. We ask for named-user access for our team rather than migrating your data into ours, which also means your claims history stays in your system if you ever leave.
Who owns our data?
You do. Because we work inside your own systems, your claims history stays there. At termination, HIPAA requires a business associate to return or destroy the protected health information it holds, where feasible (45 CFR 164.504(e)(2)(ii)(J)); the format and timeline for any data we return are set out in the service agreement.
Is outsourced billing HIPAA compliant?
A billing company is a business associate under HIPAA. AMS signs a business associate agreement with every client before any protected health information is shared (45 CFR 164.504(e)), and will set out in writing which functions are performed where.
What does outsourced medical billing cost?
A transparent percentage of collections, quoted in writing for your specialty, volume and scope. There is no published rate because the right percentage depends on those three things; there is a written definition of what it applies to, so you can compare it with any other quote.
Talk to us
The fastest way to find out whether outsourcing fits your practice is a conversation with the people who would run it. Book a call with Madison Gardner, or request a general medical billing consultation and we will come back to you with questions before we come back with a quote. Reference material, including a billing glossary and specialty CPT cheat sheets, is in our resources library.