Coding and claim mechanics are national. What changes at a state line is everything around them: who adjudicates your Medicare claims and hears your appeals, what your Medicaid program is called and whether a commercial plan sits in front of it, whether an auto injury is the health plan's problem or the auto carrier's — and how a billing company is permitted to charge you.
In Virginia, Medicare is administered by Palmetto GBA (JM). Medicaid runs as Cardinal Care, delivered largely through commercial managed care plans — so most Medicaid claims are adjudicated by an insurer with its own filing window and authorization rules rather than by the state.
Virginia is a tort state for auto injuries, so standard coordination of benefits applies rather than a no-fault carrier taking first position.
White Glove Medical Billing is a medical billing, coding, and revenue cycle company — not a healthcare provider and not a law firm. All coding is performed by certified coders from your providers' documentation; the clinical record and the certification of medical necessity remain the provider's.
At a glance
Medicare contractor
Palmetto GBA (JM)
Medicaid program
Cardinal Care
Medicaid delivery
Commercial managed care plans
Auto injuries
Tort state — standard COB applies
Appeals in Virginia
Palmetto GBA (JM) is who hears the first level of appeal for a Medicare denial here. That matters practically: an appeal argument that works with one contractor generally works across every state it covers, and local coverage determinations mean the same service can be covered in Virginia and not one state over.
What we handle for Virginia practices
- Medical coding by certified coders, from your documentation
- Charge entry, claim scrubbing, and electronic submission
- Clearinghouse rejection follow-up and denial management
- Payment posting reconciled to your bank deposits
- Aged A/R worked by recoverability, not by date
- Coordination of benefits sequenced across primary and secondary coverage
- Patient statements, payment plans, and a billing support line
A note on Virginia business taxes
Not a service we sell, and not advice — but a practice is still a business with a state footprint, and it comes up often enough to be worth stating. Virginia administers sales tax through the Virginia Department of Taxation. Most clinical services are not taxable, but retail sales — supplements, cosmetics, optical, DME sold rather than billed — frequently are. Employer registration runs through the Virginia Employment Commission, and the entity itself is registered with the Virginia State Corporation Commission. Your CPA owns all of it; we mention it because the retail side of a practice is where it usually surfaces.
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your Virginia aging, denial mix, and payer panel.
Scope and price
A written scope, and the Virginia rate card above confirmed in writing.
Transition
Coding and submission move across without a gap.
Report
Six numbers monthly, segmented by payer and provider.
Medical billing pricing in Virginia
Flat monthly fee
tracks 6–8% per month
A fixed monthly fee, set from the same size bands the percentage uses so you pay close to what the identical practice pays in a percentage state. Same economics, different instrument — quoted before we start and unchanged by what we collect in any given month.
Why Virginia is different. Virginia attaches criminal penalties to percentage-based fee-splitting arrangements. Our pricing here is set accordingly — this describes what we charge, not what you are permitted to do, and it is not legal advice.
Solo
$2,000/mo
$0–$50,000 a month collected
1 provider
tracks 8%
Growing
$7,500/mo
$50,000–$150,000 a month collected
2–4 providers
tracks 7.5%
Established
$19,250/mo
$150,000–$400,000 a month collected
5–9 providers
tracks 7%
Group
$45,500/mo
$400,000–$1,000,000 a month collected
10–20 providers
tracks 6.5%
Large Group
from $60,000/mo
$1,000,000+ a month collected
20+ providers or multi-site
tracks 6%
Every ongoing engagement carries a minimum monthly fee of $500. It exists so a new or small practice can be served properly rather than quoted a percentage that does not cover the work.
What changes the work in Virginia
- Medicare contractor
- Palmetto GBA (JM)
- Claims for Virginia providers are adjudicated here, and this is who hears the first level of appeal.
- Medicaid program
- Cardinal Care
- Delivered largely through commercial managed care plans, so most Virginia Medicaid claims go to a health plan rather than to the state.
Virginia shares its Medicare contractor with North Carolina, South Carolina and West Virginia, so an appeal that works in one usually works in the others.
Front-end services in Virginia
These are priced per occurrence and are the same in every state. They can be bought on their own, without a billing contract.
| Eligibility check | $5 per patient |
| Full benefits verification | $10–$14 per patient |
| Prior authorization, standard | $12 per authorization |
| Prior authorization, complex | $18–$25 per authorization |
| Patient registration audit | $4 per patient |
What we report every month
- Days in A/R — How long money takes to arrive.
- A/R over 90 days — What share of what you are owed is going stale.
- Clean claim rate — How often a claim is paid without rework.
- Net collection rate — Of what was collectable, how much we collected. The number that grades the whole engagement.
- Denial rate by reason — Grouped by cause, so it points at a fix rather than a total.
- Charge lag — Days from date of service to claim submission — often your number to fix rather than ours, which is exactly why you can see it.
Virginia Guides
Virginia Sales Tax Filing
Tracked, reconciled, and filed on the cadence Virginia assigns you.
Open guideVirginia Tax Agency Directory
Who administers what, with rates and thresholds as of August 2026.
Open guideAll Medical Billing Services
Monthly close, cleanup, AR/AP, payroll, job costing, and more.
Open guideVirginia Medical Billing by Specialty
These specialties have medical billing that genuinely differs in Virginia — workers compensation schedules, no-fault auto rules, or Medicaid structure.
Virginia — Frequently Asked Questions
Which Medicare contractor covers Virginia?
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Palmetto GBA (JM). That is who adjudicates your Medicare claims, publishes the local coverage determinations that bind you, and hears a redetermination.
Is Virginia Medicaid managed care?
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Cardinal Care is delivered largely through commercial managed care plans. Nationally about 78% of Medicaid beneficiaries are in comprehensive managed care, and five companies account for roughly half of that enrollment — so "billing Medicaid" here usually means billing a commercial insurer.
How do you price in Virginia?
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Virginia attaches criminal penalties to percentage-based fee-splitting arrangements. Our pricing here is set accordingly — that describes what we charge, and your own position is a question for your counsel rather than for us.
Do we have to be in Virginia to work with you?
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No — we work remotely with practices in all 50 states and DC. What matters is that somebody is tracking Virginia's rules against your actual claims, which is what this page is for.
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