Maximise Reimbursements with Inpatient Billing Experts

MedsIT Nexus has a dedicated team specialized in the hospital billing and collection process, applying their experience and best practices in recovering aged invoices and managing claim denials that increase 98% of the institution's net collection rate and maximize the cash flow.

Expertise in Inpatient Facility Setting

MedsIT Nexus specializes in MS–DRG–based billing for acute care hospitals, LTACHs, IRFs, and SNFs. We ensure accurate DRG assignment, clean claims, and compliant documentation. Our best practices streamline inpatient revenue cycles, reduce denials, and accelerate reimbursements for diverse inpatient facility types.

Knowledge of MS-DRG Reimbursement method, Complex bundling and unbundling techniques

Our medical coding experts have vast experience in translating complex inpatient care scenarios into the required medical codes

MedsIT Nexus medical billing staff is proficient in completing the CMS-1450 (UB-04) form accurately with relevant codes and appropriate Type of Bill (TOB), which results in increasing the first-pass claim rate

With expertise in medical billing for inpatient facilities, we enhance revenue cycle efficiency while maintaining strict compliance with Medicare and commercial payers.

Hospital Credentialing Services - MedsIT Nexus

Inpatient Facility Diagnostic Services

At MedsIT Nexus, our hospital billing specialists bring extensive expertise in Medicare Part A billing, specifically for diagnostic services rendered in inpatient facility settings. We ensure full compliance with regulatory requirements while optimizing reimbursement and streamlining revenue cycle management (RCM) for hospitals.

Precise classification of claims based on patient status (inpatient vs. observation), provider roles, and facility type to ensure accurate DRG assignment and coding integrity

Applying Inpatient Prospective Payment System (IPPS) methodologies, including MS-DRG and revenue code alignment, to support correct billing and reimbursement

Technically distinguishing diagnostic services performed by the hospital’s in-house laboratory staff from those outsourced to external or reference labs, ensuring accurate billing and compliance with CMS guidelines

With a strong focus on inpatient facility billing, we ensure accurate diagnostic service documentation, compliance with CMS guidelines, and maximized reimbursement—all while facilitating seamless coordination between clinical and billing departments.

APP Services in Inpatient Facility Settings

At MedsIT Nexus, our hospital billing experts specialize in optimizing billing and reimbursement for Advanced Practice Providers (APPs) within inpatient facility settings. We navigate the complexities of Medicare Part B billing to ensure full compliance, accurate reporting, and maximized reimbursement. Our comprehensive RCM support includes

Accurately classifying claims based on APP employment structure (employed vs. contracted), scope of practice, and inpatient place of service (POS) to ensure correct CPT® and HCPCS coding under Medicare Part B when applicable

Ensuring compliance with split/shared visit rules and billing guidelines for APP services in inpatient settings, including appropriate modifier usage and attestation requirements

Leveraging extensive experience in DRG bundling, our team ensures that inpatient facility services are adequately documented, properly attributed, and reimbursed appropriately under Medicare Part A, avoiding missed revenue opportunities

With deep knowledge of inpatient billing regulations and APP-specific guidelines, MedsIT Nexus ensures compliant, accurate, and revenue-optimized billing for APPs within hospital inpatient settings.

DME Billing in an inpatient facility

MedsIT Nexus medical billing professionals expertly create documentation to establish medical necessity, ensure payer compliance, and align with inpatient-specific reimbursement rules, particularly under Medicare Part A bundled payment models. Our specialised services include

Ensuring accurate documentation of DME used in the inpatient stay to support inclusion within the DRG payment, and verifying the alignment of physician orders with clinical usage

Classifying and reporting DME-related charges appropriately on the UB-04 claim form, ensuring consistency with revenue codes, HCPCS Level II codes, and hospital chargemaster practices

Maintaining compliance with Medicare and commercial payer requirements, especially for items that may be separately billable under specific contractual arrangements or patient status exceptions

Connect with MedsIT Nexus to strengthen your hospital’s inpatient DME billing process, ensuring compliance, accuracy, and optimized revenue within the DRG payment framework.

Hospitalist Physicians Medical Billing and Reimbursement

MedsIT Nexus hospital billing experts specialize in billing solutions tailored to the specialties of hospitalist physicians. Our professionals have a deep understanding of Medicare Part B physicians’ billing and reimbursement requirements, enabling them to manage the complexities of inpatient revenue cycle processes effectively

Physicians' services in inpatient units are billed under the CMS-1500 form, following a unique set of Medicare Part B requirements. These include the unique E/M medical coding set, split shared billing, and medical necessity documentation for hospital admissions—all of which our dedicated experts handle with great precision

MedsIT Nexus has a dedicated team of medical coding professionals with deep experience and expertise in applying inpatient-specific (E/M) codes. Our best practices ensure that every patient’s journey is accurately captured for maximum reimbursement and compliance

Our medical billing team expertly handles the challenges associated with bundling services for hospitalist physicians, such as the Global Surgical Package, Split Shared Visits, and Modifiers or NCC edits. Our expert management streamlines the claims processing, resulting in exceptional revenue generation for the organization

Focus on patient care, not paperwork. Let our expert team handle your hospitalist inpatient billing, ensuring every claim is accurate and compliant and that you are paid promptly.

Maximise Reimbursements with Hospital Outpatient Billing Specialist

MedsIT Nexus has a dedicated team that specializes in outpatient facility-level billing. With significant knowledge of the required reimbursement methods, unique billing and coding requirements, our professionals navigate the everyday challenges of recovering aged invoices and managing claim denials that result in increasing institution's net collection rate and maximizing the cash flow

Expertise in Outpatient Facility Setting

MedsIT Nexus has hospital billing professionals who specialize in the required reimbursement methods. With expert knowledge in the revenue cycle processes, our team ensures accurate claims processing for the complex patient care scenarios that take place in the provider & non-provider-based Emergency Room, Urgent Care Centers, and ASCs, resulting in enhanced financial performance of your organization

Our team has significant knowledge and experience in the OPPS & APC reimbursement system, enabling us to streamline billing and claims processing for hospital outpatient services

Our team is equipped with medical coding experts specializing in the required medical coding set in the outpatient setting. Ensuring proper reimbursement with accurate code assignment

Our professionals expertly create and process UB-04 claims with the required billing codes, ensuring accurate and compliant billing for hospital outpatient facility settings

With cutting-edge billing technology and a commitment to precision, our best practices result in enhanced financial performance for the outpatient facilities of your organization.

APPS Services In Outpatient Facility Services

MedsIT Nexus hospital billing experts are specialised in At MedsIT Nexus, our hospital billing specialists excel in Medicare Part B outpatient billing, ensuring compliance and optimal reimbursement for Advanced Practice Providers (APPs) in hospital-based outpatient settings. With the following expertise, we streamline the RCM process

Accurately classifying claims based on provider employment structure and place of service (POS) to ensure correct CPT® and HCPCS coding

Applying Ambulatory Payment Classification (APC) reimbursement models for outpatient facility services

Separating technical and professional components for services like diagnostic tests and therapeutic procedures

Our expertise in hospital-based outpatient billing ensures precise documentation, regulatory compliance, and maximized reimbursement while maintaining seamless coordination with hospital departments.

Outpatient Diagnostic Billing Services

At MedsIT Nexus, our hospital billing experts specialize in APC-based reimbursement for outpatient diagnostic services. We accurately differentiate between hospital lab services, outsourced diagnostic tests, and reference lab services, ensuring precise claim categorization for optimal reimbursement. Our revenue cycle professionals streamline hospital outpatient billing by

Assigning the correct CPT® and HCPCS Level II codes for outpatient diagnostic procedures

Ensuring accurate claim classification under UB-04 for institutional billing and CMS-1500 for professional claims

Separating interpretation services provided by specialty physicians and processing professional claims for compliance with outpatient billing regulations

With our expertise in hospital-based outpatient billing, we enhance revenue cycle efficiency while ensuring strict compliance with Medicare and commercial payers.

Outpatient DME billing

Successful medical billing and reimbursement for Durable medical equipment requires meticulous documentation to establish medical necessity and ensure compliance with payer policies. Medical coding and documentation errors can lead to claim denials and delayed reimbursements. Following outpatient billing best practices, our medical billing and coding team ensures healthcare organizations sustain their revenue stream

MedsIT Nexus hospital billing experts specialize in the outpatient billing and reimbursement system. Our professionals deeply understand the scenarios where DME is billed and reimbursed through the OPPS grouping system or separately under the Medicare Part B DMEOPS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) fee schedule

With a thorough understanding of UB-04 & CMS 1500 claims processing for DME usage in the outpatient setting, our medical billers and coders classify claims based on real-world scenarios, which ensures accurate reimbursement, resulting in generating a steady revenue

Our revenue cycle team is equipped with certified and accredited medical coding experts with proficient knowledge in HCPCS level II outpatient medical coding set. Our best practices in applying the required medical codes result in streamlining the claims processing that maximizes the revenue of outpatient facility

Connect with our team to enhance hospital outpatient revenue cycle efficiency. With expertise in DME billing, our team ensures strict compliance with Medicare and commercial payers.

Outpatient Physician Billing & Reimbursement

At MedsIT Nexus, we specialize in billing solutions tailored to the needs of outpatient physicians across various specialties. Our billing experts have deep knowledge of Medicare Part B billing requirements, helping outpatient providers manage complex revenue cycle processes with unmatched accuracy and efficiency

MedsIT Nexus professionals follow specific E/M coding guidelines and document medical necessity. Our certified coding experts ensure every claim is coded correctly and supports compliant reimbursement

MedsIT Nexus has a dedicated team of medical coding professionals who proficiently apply (E/M) codes to outpatient encounters, ensuring the proper level of selection and supporting documentation

We ensure accurate claims processing for outpatient services, including minor surgical procedures, in-office treatments, diagnostic testing, and related services, maximizing reimbursement and minimizing denials

Let MedsIT Nexus take the complexity out of outpatient physician billing. Our team ensures every claim is accurate, compliant, and paid promptly, so you can focus on what matters most: patient care.

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Hospital Revenue Cycle Management Services

With our hospital revenue cycle management services, you can maximize reimbursements, reduce denials, and streamline workflows. From patient access to final payment, we ensure your facility stays financially healthy and audit-ready.

Maximize Reimbursement Potential
Enhance Compliance & Mitigate Risk
Strengthen Audit Readiness
Gain Institutional Billing Expertise on Demand

Accelerate Reimbursements from Day One
Ensure Full Compliance with Payer & State Requirements
Simplify Complex Credentialing Workflows through Automation
Gain a Credentialing Partner Who Understands Hospital Operations

Ensure Full Compliance and Coding Accuracy
Strengthen Audit Readiness with Clean Documentation
Reduce Coding-Related Claim Denials
Certified Coders with Hospital-Level Expertise

Accelerate Cash Flow Across Departments
Recover More from High-Dollar Claims
Reduce Aging A/R and Improve DSO
Expert Management of Institutional Claim Complexities

Resolve Department-Specific Revenue Gaps
Compliance Focused Strategy Built for Hospitals
Minimize Write-Offs on High-Value Claims
Accelerate Appeals with Expert Documentation

Prevent Denials at the Source
Streamline Admissions with Real-Time Verification
Protect High-Value Services from Delays
Boost Cash Flow with Clean Claims

Medical Billing Audit
Ensure your hospital’s revenue integrity with our expert Hospital Billing Audit services. We dive deep into UB-04 claims, revenue codes, and DRG assignments to uncover missed charges, compliance risks, and documentation gaps. Our audits validate inpatient vs. outpatient status, charge capture accuracy, and alignment with Medicare regulations. Protect your facility from denials, maximize reimbursements, and stay audit-ready with a partner who understands the complexity of institutional billing.
Medical Billing & Credentialing
Get your hospital credentialed with confidence. Our Hospital Facility Credentialing service ensures your facility meets all payer and regulatory requirements — from NPI Type 2 setup to Medicare, Medicaid, and commercial insurance enrollments. We handle licenses, CLIA, DEA, and accreditation verification to position your hospital for seamless institutional billing. Stay compliant, avoid denials, and accelerate your reimbursement process with a credentialing partner who understands the complexity of facility-level approvals.
Medical Billing & Coding
Optimize your hospital’s revenue with our expert Hospital Coding Services. We specialize in accurate facility coding and APCs to ensure compliance and maximize institutional reimbursement. From inpatient to outpatient settings, our certified coders translate complex clinical documentation into precise codes that reflect your hospital’s services. Reduce denials, improve audit readiness, and streamline billing cycles with a team that understands the intricacies of hospital-level medical coding.
Hospital AR Billing Management
Maximize hospital revenue and minimize payment delays with our expert Hospital Accounts Receivable Management Services. We specialize in managing complex institutional claims, resolving denials tied to DRGs, APCs, and revenue codes, and accelerating cash flow across inpatient and outpatient services. Our team handles high-dollar claims, payer audits, and underpayment recovery with precision. From aging A/R follow-up to secondary billing, we ensure your hospital gets paid faster and more accurately. Trust a team that understands the unique A/R cycle of hospital facilities and delivers results that improve your bottom line.
Hospital Denial Management
Turn hospital denials into recovered revenue with our specialized Hospital Denial Management Services. We tackle complex denials tied to DRGs, APCs, medical necessity, and inpatient status disputes—backed by thorough documentation and expert appeals. Our team works across departments to resolve high-value claims quickly, reduce write-offs, and prevent future denials through root cause analysis. Whether it's authorization gaps, level-of-care rejections, or coding inconsistencies, we bring precision and persistence to every case. Safeguard your revenue cycle with a denial management strategy built for hospital-level complexity and compliance.
Hospital Insurance Verification Services
Ensure uninterrupted care and faster reimbursements with our expert Hospital Insurance Verification Services. We verify multi-level coverage across inpatient, outpatient, and surgical services—coordinating with payers to confirm benefits, eligibility, and preauthorization requirements. From high-cost diagnostics to complex admissions, we handle every detail to prevent claim denials and delays. Our team navigates payer rules, secures real-time approvals, and provides the documentation hospitals need to stay compliant. Trust us to protect your revenue from the very first step in the billing cycle.

Boost Cash Flow and Cut Costs with Proven Hospital Billing Solutions

Discover accurate credentialing with MedsIT Nexus's innovative portal. Thecredentialing offers a quick way for providers to include their details and get credentialed.

Model Specific Billing

Multi-Dept Billing

Employment Billing

Max. EHR integration

Compliance Billing

Multi-Facility Billing

Experience Effortless Credentialing with MedsIT Nexus!

Paperless Credentialing Process

Eliminates paperwork, streamlining credentialing with automation for faster approvals, improved accuracy, and regulatory compliance.

Cost-Effective Solutions

Reduces administrative workload and automates credentialing, helping healthcare facilities lower costs while ensuring compliance.

Faster Claims Resolution

Accurate credentialing minimizes claim errors, accelerates approvals, and ensures timely reimbursements, improving cash flow.

Tailored Billing for Every Hospital Ownership Model

Whether you're a public, private, non-profit, or for-profit hospital, our billing solutions adapt to your financial ecosystem. We align with your revenue model and payer mix, handling Medicare, Medicaid-heavy claims, charity care adjustments, and sliding-scale billing. In for-profit systems, we drive faster cash flow with aggressive, compliant RCM strategies.

Need a customized billing plan based on your hospital’s structure

Non-Pediatric care Physicians

93%

New patients

72%

Private insurance

94%

Private patients

80%

Doctors lose up to

$125

Billion in U.S

Because of poor billing practices

Hospital Billing Experience That Anticipates Transition Complexities Before They Disrupt Reimbursement

When hospital patients transition into outpatient settings, every coding detail & reimbursement rule must align or revenue is at risk. We manage these touchpoints before they become denial triggers.

Our medical billing strategies handle post-discharge transitions

Whether a patient is discharged to an SNF, HHA, or returns for services in a HOPD or ASC, each transition comes with billing risks that can snowball into denials. We bridge every stage of the care continuum, ensuring your inpatient billing aligns with the outpatient services that follow.

Inpatient ➝ SNF

Discharge codes + PDPM compliance

When a patient transitions from an inpatient bed to an SNF, the billing process enters a new compliance phase, guided by the PDPM rather than the DRG system. Learn how our SNF billing services ensure smooth reimbursement continuity across the care settings

Inpatient ➝ Home Health

OASIS syncing + HHA PPS timelines

Patients transitioning into Home Health Care must be carefully evaluated for LUPA thresholds and episode timing. Explore our HHA billing solutions to see how we handle post-hospitalization complexities

Inpatient ➝ HOPD

3-Day Rule + bundling logic

Transitioning to a Hospital Outpatient Department (HOPD)? We audit whether any post-discharge services fall under the 3-Day Payment Window and ensure the outpatient charges are properly bundled or split, based on facility type & provider affiliation. Navigate to the outpatient
billing to further explore a required
solution.

Inpatient ➝ Private Practice

E/M services coding + continuity of care billing

Physicians providing follow-up care must bill with precision, especially when visits occur within global periods or after complex surgeries. See how we support
private practices in managing
post-inpatient care.

Inpatient ➝ oP therapy billing services

Medicare Caps + POS codes

Outpatient rehabilitation often follows inpatient care, especially after orthopedic or neurological procedures. Understand how our therapy billing workflows support seamless transitions.

Inpatient ➝ (FQHC) Billing Services

Encounter-level billing + FQHC compliance

For underserved or rural populations, FQHCs often take over the care continuum after patients are discharged. Explore how we ensure compliance and accurate encounter billing in FQHC
environments.

Clinical Billing Services

Two Distinct Paths & One Integrated Billing Strategy

MedsIT Nexus is a full service revenue cycle company, equipped with certified billing professionals, auditors, and compliance analysts who understand how clinical workflows translate into billing logic, especially when applied to hybrid hospital structures that combine inpatient departments, outpatient clinics, and off-campus sites. We bring the clarity hospitals need to accurately bill clinical services under CMS regulations, commercial payer rules, and internal financial goals

Schedule a Discovery Call Book Now

Provider Based Clinical Billing

We assist hospitals in billing outpatient departments (HOPDs) as provider-based under CMS’s strict requirements outlined in 42 CFR 413.65

Accurate facility vs. professional component billing

Modifier -PO and 3-day rule compliance

Split billing across UB-04 and CMS-1500 forms

Documentation support for Provider-Based Status criteria

Revenue recognition aligned with OPPS and cost reporting

With the above expertise, we help you maintain compliance, whether you're managing a hospital-based clinic or aligning services with affiliated group practices operating under shared clinical and administrative structures.

Non Provider Based Clinical Billing

When clinical services are billed independently from the hospital entity, such as Independent Clinics & Outpatient Sites, urgent care centers, or freestanding facilities, we ensure

Proper use of POS codes

Clear delineation of facility and professional fees

Accurate CPT/HCPCS coding for outpatient encounters

Alignment with commercial payer requirements and fee schedules

Seamless claim flow from encounter to remittance

We build workflows that align clinical intent with financial classification, ensuring billing clarity that withstands audits and prevents denials

What We Deliver

Our outsourced hospital billing services are built to integrate seamlessly with your existing systems, teams, and financial goals, delivering measurable outcomes at every stage of the revenue cycle.

End-to-End Billing Management

From charge entry and coding to claims submission, follow-up, and payment posting, we manage the full billing lifecycle with transparency and accountability.

Specialty-Specific Billing Expertise

Dedicated teams for inpatient, outpatient, surgical, ED, imaging, and ancillary services — ensuring accurate, department-specific reimbursement.

Denial Prevention & Recovery

Proactive edits, payer rule monitoring, and real-time denial management workflows that reduce revenue leakage and accelerate cash flow.

Compliance & Audit Preparedness

Built-in processes for HIPAA, OIG, CMS, and payer compliance — plus audit response support when needed.

Scalable Staffing & Technology

Leverage our skilled billing professionals, certified coders, and advanced RCM technology, with the flexibility to grow with your hospital’s needs.

Analytics & Reporting

Actionable dashboards and monthly performance reviews that give your leadership complete visibility into revenue performance, trends, and opportunities.

How MedsIT Nexus Helped Renowned Hospitals In the USA Cut Costs, Speed Up Reimbursements, and Build Resilient RCM

42% Denial Rate Reduction for a Regional Hospital MedsIT Nexus reduced denials by 42% in six months by auditing coding accuracy, aligning charge capture workflows, and applying payer-specific edits, while training clinical and billing teams to prevent revenue leakage and accelerate reimbursement by 11 A/R days.

$2.1M Revenue Recovery in Provider-Based Clinic Billing

A multi-department hospital lost revenue due to improper split billing in provider-based outpatient clinics. MedsIT Nexus restructured their PBCB model and built a compliant documentation trail aligned with CMS regulations. This results in recovering $2.1 million in missed reimbursements, and billing compliance was strengthened to prevent future audits.

EHR Migration with Zero Cash Flow Disruption

During an Epic EHR transition, billing interruptions threatened revenue stability. MedsIT Nexus worked closely with clinical and IT teams to create parallel workflows, pre-loaded coding logic, and staffed a go-live support desk. As a result, the hospital experienced zero cash disruption, complete charge continuity, and resumed post-live billing within 48 hours

Billing Centralization Across 5 Hospital Campuses

Fragmented billing processes across a five hospital system caused duplication, denial spikes, and lost revenue. Our centralized operations, standardized SOPs, and a unified billing platform result in an 18% decrease in operational costs, a 22% increase in claim collections, and a surge in billing staff productivity, all without adding headcount

Accelerating Time-to-Cash for a Specialty Surgical Hospital

A specialty surgical hospital struggled with long claim cycles and payer underpayments. MedsIT Nexus integrates automated eligibility checks, real-time claims scrubbing, and a dedicated payer negotiation team. This led to a 21-day reduction in time-to-cash, a significant drop in underpaid claims, and a 93% success rate in appeals

Restoring Billing Compliance for a Rural Critical Access Hospital (CAH)

MedsIT Nexus overhauled outdated billing at a Critical Access Hospital by aligning processes with Medicare CAH rules, retraining staff, and optimizing workflows for swing-bed and telehealth billing, resulting in 98% claim approval and a 17-day reduction in reimbursement time, all while restoring revenue integrity and operational confidence

Our services are trusted by 2000+ providers

Dr. Ndidi Uka

A-plus Dentistry

"I want to thank MedsIT Nexus for their impeccable service. They are incredibly knowledgeable and work to make sure you receive the maximum reimbursement. Sam, my dedicated Practice Manager, is always available to answer my questions and keep my abreast on the status of my submitted claims. Being able to bill medical services has allowed me to offer the best care."

M. Techeira

Family Medicine

"We are an outpatient family medicine/ primary care practice. Have offices in NYC and Nassau County. MedsIT Nexus handles all our medical billing and insurance claims. We switched from another company and the process was hassle free, no fees and FAST which was important since we operate 6/7 days. They are always available to answer any questions. We definitely recommend!"

Memoona Waheed

Family Medicine & Pain Management

"After reviewing different medical billing companies, I came across MedsIT Nexus. Not only do they offer billing and coding services, but specialize in credentialing and unpaid claims. Their staff is knowledgeable, professional and are easily accessible- inquiries are answered quickly. Thank you MedsIT Nexus for helping us improve our healthcare practice at a competitive rate!"

S. Dhillon

Physical Medicine & Rehabilitation

"I am the manager at a private physical medicine & rehabilitation practice. We operate in 2 different boroughs in NYC through multiple clinics. MedsIT Nexus handles all our medical billing, coding, denials and prior authorizations for all procedures. We are pleased with their same day approvals as well. Their staff is easily accessible, fast & pleasant to work with."

Hospital Billing Services

Ensure Reimbursement

10%

30%

90+

98%