Revenue cycle management that turns documented care into collected revenue
Practices that outsource medical billing rarely have a billing problem. They have a leakage problem. Charges never posted, claims denied for fixable reasons, underpayments accepted without challenge, balances aging past appeal. Our revenue cycle management team closes each of those leaks, with denial management, AR recovery and coding review, and reports the numbers back to you every month.
A billing department that never calls in sick
You get a named account manager, a specialty-matched billing team, a certified coder and an AR analyst, for less than the fully loaded cost of one in-house biller.
We run the entire cycle from the moment a patient books to the moment the last dollar posts. That means eligibility checked before the visit, coding reviewed against your documentation, claims scrubbed against payer-specific edits, payments posted and reconciled line by line, denials worked as a priority queue rather than a monthly cleanup, and patient balances handled with statements people can actually understand.
Nothing is offshored away from your visibility. You keep your systems, your data and your patient relationships. We bring the discipline, the capacity and the payer knowledge.
Where practices lose money
The five leaks we find in almost every audit, and what we do about each one.
- Eligibility not verified. We check benefits, deductibles and plan changes before the appointment, not after the denial.
- Under-coding out of caution. Certified coders align codes to what your documentation actually supports, no more and no less.
- Denials never reworked. Every denial enters a tracked queue with an owner and a deadline until it is paid or formally closed.
- Underpayments accepted. We reconcile every remit against your contracted fee schedule and challenge short payments.
- Patient balances ignored. Clear statements, digital payment options and respectful follow-up recover what insurance does not cover.
Ten stages. One accountable team.
This is the exact path every encounter takes through our billing operation, with the checkpoints that keep claims clean and cash moving.
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Step 01
Patient Registration
Demographics, guarantor details, insurance IDs and consent captured accurately at the front door, because 20% of denials trace back to a registration error nobody caught.
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Step 02
Insurance Verification
Real-time eligibility, active coverage, deductible and copay status, plan limitations and coordination of benefits confirmed before the visit so patient responsibility is known up front.
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Step 03
Prior Authorization
Authorization requirements identified by CPT and payer, clinical documentation assembled, requests filed and tracked to approval, with peer-to-peer review scheduled when a medical director needs to weigh in.
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Step 04
Medical Coding
Certified coders assign ICD-10-CM, CPT and HCPCS codes with correct modifiers, checked against NCCI edits, LCD/NCD policies and specialty bundling rules, with documentation queries sent back when support is thin.
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Step 05
Claim Submission
Claims scrubbed against payer-specific edit libraries, corrected before they leave, then transmitted electronically within 24 hours. Clearinghouse acknowledgements and rejections are reconciled the same day, so no claim goes silent.
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Step 06
Payment Posting
ERA and manual EOB payments posted line by line, adjustments verified against your contracted rates, and secondary claims triggered automatically. Every short payment is flagged for review instead of quietly written off.
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Step 07
Denial Management
Denials categorized by root cause within 48 hours: eligibility, authorization, coding, medical necessity, timely filing or bundling, then corrected, resubmitted and fed back into our scrubbing rules so the pattern stops repeating.
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Step 08
Appeals
Formal appeals built with medical necessity letters, clinical records, policy citations and contract language, escalated through first level, second level and independent external review, each with its deadline tracked.
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Step 09
Patient Statements
Clear, itemized statements that patients understand, sent on a defined cycle with online payment links, text and email reminders, and a courteous support line that protects your reputation while collecting the balance.
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Step 10
Revenue Reports
A monthly financial package: collections against expectation, AR aging buckets, denial root causes, payer performance, provider productivity and net collection rate, plus a call where we walk you through what changed and why.
Everything included in your revenue cycle engagement
Engage the full cycle, or plug us into the specific stage where your practice is losing ground.
Revenue Cycle Management
The complete cycle owned end to end, from registration through to final payment, with a single accountable team, defined service levels and weekly working sessions with your staff.
Aged AR Recovery
A dedicated project team works balances over 60, 90 and 120 days: re-verifying eligibility, re-billing inside timely filing windows, appealing what is appealable and documenting what genuinely is not.
Medical Coding & Audits
Certified coders code from your documentation and run periodic compliance audits, so you capture the revenue you earned without drifting into risk. Coding education for providers is included.
Claim Scrubbing
Multi-layer edits catch demographic mismatches, invalid modifier combinations, missing authorizations and payer-specific formatting errors before submission, the single biggest driver of our clean claim rate.
Insurance Follow-up
Unpaid claims are pursued by phone and portal on a fixed cadence, not left to age. Every call is logged with a reference number, a payer representative name and the next action date.
Denial Management
A structured denial program with root cause categorization, corrective feedback into coding and front-desk workflows, and a monthly report showing which payers and codes drive your denials.
Analytics
Net collection rate, first-pass yield, days in AR, denial rate by payer, procedure-level profitability and provider productivity: the metrics that tell you where to act, not just what happened.
Reporting
Standard monthly reporting plus custom views for partners, lenders or board meetings. Reports are written in plain English with a summary of what changed and what we are doing about it.
Out-of-Network Billing
Single case agreements, usual and customary benchmarking, negotiation support and appeals for practices that stay out of network by choice. See the out-of-network overview.
What changes in your practice within 90 days
Outsourcing billing should be felt at the front desk and on the bank statement, not just in a monthly PDF.
- Predictable cash flow. Consistent daily submission and disciplined follow-up smooth out the peaks and troughs practices live with.
- Lower overhead. No recruiting, salaries, benefits, PTO coverage, billing software seats or turnover risk to absorb.
- Fewer write-offs. Timely filing misses and unworked denials, the two most expensive silent write-offs, are systematically eliminated.
- Happier front desk. Your staff stops fighting payers on hold and goes back to caring for patients in the room.
- Audit readiness. Coding discipline and documentation queries reduce your exposure long before a payer audit letter arrives.
- Room to grow. Adding a provider, a location or a service line no longer means rebuilding a billing department.
The numbers on your monthly scorecard
| Metric | Target |
|---|---|
| First-pass clean claim rate | 98%+ |
| Net collection rate | 95%+ |
| Days in accounts receivable | Under 25 |
| AR over 90 days | Under 12% |
| Denial rate | Under 5% |
| Denial overturn rate | 96% |
| Charge lag (visit to submission) | Under 24 hours |
Targets are set during onboarding against your specialty and payer mix, then reviewed together every quarter.
Know exactly what your AR is worth before you commit
Free accounts receivable analysis · Written findings · No obligationQuestions practices ask before switching billers
Prefer to talk it through? Call +1 (866) 308-8907.
Ten to fifteen business days for a standard practice. Week one is discovery, system access, fee schedule loading and an audit of your open receivables. Week two runs parallel submission so no claim is dropped during the handover. From day 15 we submit your full volume and begin working the legacy AR you transfer to us.
No. We work inside the systems you already own and the licenses stay in your name, which means your data remains yours if we ever part ways. Our billers work daily across the major cloud EHR, practice management and clearinghouse platforms, so there is no learning curve billed to you.
It depends entirely on how much of the balance still sits inside timely filing and appeal windows, and on the denial reasons behind it. That is why we run a free AR analysis first: every open balance is classified as recoverable, appealable or genuinely closed, so you see the realistic number before any work starts rather than after an invoice arrives.
Every denial is categorized by root cause within 48 hours, then corrected and resubmitted or appealed with the documentation that payer requires. The root cause is fed back into our scrubbing rules and, where relevant, into front-desk and coding workflows so the same denial does not recur. You receive a monthly denial report showing which payers, procedure codes and providers are driving the volume.
As a percentage of collections, which keeps our incentives aligned with yours. We are paid when you are paid. The rate depends on specialty, monthly claim volume, average claim value and payer mix, and it is confirmed in writing after your free practice assessment. Aged AR clean-up projects can be quoted separately on a recovery basis.
Complete visibility. You keep administrative access to your own systems and can review every claim, note, appeal and payment in real time. On top of that you get a monthly performance report and a weekly working call, so you are never dependent on logging in to find out where things stand.
Yes, and it is one of the biggest advantages of running both with us. Our credentialing team knows exactly which payers your billing team depends on, so enrollment is sequenced around your revenue rather than alphabetically. If a new provider also needs a license in another state, our licensing team starts that in parallel.
Let's find the money already sitting in your system
Send three months of remittance data and your current AR aging. We will return a written analysis of denial patterns, underpayments and recoverable balances, free, and yours to keep either way.