Eligibility & benefits verification
Real-time and batch checks before the visit, with deductible, co-insurance and coverage-limit detail written back to the schedule.
01 · Billing & RCM
Medical Billing & Revenue Cycle Management
Your billing office, fully staffed — charge entry through final payment, with the numbers to prove it. We work inside your PM system, under your tax ID, and report to you weekly.
Engagement at a glance
- Engagement modelPercentage of net collections or per-provider flat fee
- Ramp-up10–15 business days to full production
- SystemsWe work in your PM/EHR — Athena, eCW, NextGen, Epic, Tebra, AdvancedMD and 30+ more
- ReportingWeekly A/R snapshot, monthly revenue review, quarterly payer scorecard
- StaffingDedicated biller and certified coder per account, plus a named account manager
- ComplianceHIPAA-aligned, BAA in place, full audit trail on every touch
< 5%
Aged A/R over 120 days
Industry benchmark is 12–20% for practices billing in-house.
98%
First-pass clean-claim target
Claims scrubbed against payer rules before they leave the building.
48 hrs
Charge-entry turnaround
Encounter closed to claim submitted, every business day.
The problem
Revenue you have already earned, collected on time.
Most practices do not have a coding problem or a payer problem — they have a capacity problem. Claims sit in a queue, denials age past the appeal window, and write-offs get posted because nobody has time to work them.
We take the whole revenue cycle off your front and back office: eligibility and benefits verification before the visit, charge capture and coding review after it, claim submission, payer follow-up, denial appeals, patient responsibility and payment posting. Your staff keep the patient relationship; we keep the money moving.
You get a named account manager, a monthly revenue review, and a dashboard that shows exactly where every dollar is sitting — by payer, by provider, by age.
What's included
Everything in this service, in writing.
Charge capture & claim scrubbing
Charge tickets reconciled against the schedule so nothing goes unbilled, then scrubbed against payer-specific edits before submission.
Prior authorization
Payer-specific auth requirements tracked and filed ahead of the date of service — including retro-authorizations.
Denial management & appeals
Every denial categorised, worked and appealed with clinical documentation attached; root causes fed back to coding and front desk.
Payment posting & reconciliation
ERA and EOB posting, contractual adjustment verification, underpayment flags, and monthly reconciliation to bank deposits.
Patient financial experience
Clear statements, card-on-file and payment-plan options, and a patient line your patients can actually reach.
How it runs
The engagement, step by step.
01
Discovery & baseline
We pull 12 months of claims, remits and A/R aging, then quantify leakage: denials by category, untimely filing, underpayments, and charge lag.
02
Transition in place
We work inside your existing systems and phone numbers. No data migration, no downtime, no new software for your staff to learn.
03
Steady-state operations
Daily huddles, claims out the door within 48 hours, denials worked inside 7 days, and a weekly report you can read in five minutes.
04
Review & improve
Monthly revenue review with your leadership: payer performance, coding trends, front-desk fixes, and a written action list.
What we hold ourselves to
These are the operational targets we report against for this service. They are industry benchmarks and internal commitments — your results depend on your volume, payer mix and specialty, and we will tell you honestly where you should expect to land.
95%+
Clean-claim rate
< 30 days
Average days in A/R
< 5%
A/R over 120 days
< 3%
Net collection write-off
FAQ
Common questions.
Do we have to change our practice management software?
No. We work inside your existing PM/EHR under your credentials and your tax ID. If your system is genuinely holding you back we will say so and scope a migration separately — but it is never a condition of working with us.
How do you charge for billing?
Either a percentage of net collections or a flat monthly fee per provider, agreed up front. Percentage pricing typically lands between 4% and 8% depending on volume, payer mix and specialty; flat-fee pricing is usually better for high-volume, low-complexity practices.
What happens to our existing billing staff?
Usually they get better work. Most practices move their team onto patient-facing and clinical-support tasks and let us absorb the payer calls, appeals and posting. Where a practice is winding down in-house billing, we help with the transition plan.
How quickly will we see the difference?
Cash typically moves within the first 30 days as aged claims are worked. The structural improvement — clean-claim rate, charge lag, denial rate — shows up in the 60 to 90 day range once the backlog is cleared.
Who owns the data?
You do, always. We work in your systems, and on exit we hand back every work queue, policy document and report in a standard format.
Related services
Often bought together.
Medical Coding & Documentation Integrity
Certified specialty coders, E/M level review, surgical and procedural coding, CDI queries and coding education that sticks.
- Specialty-matched AAPC and AHIMA certified coders
- E/M level distribution and modifier review
- Documentation improvement, not just code correction
Credentialing & Payer Enrollment
Payer enrollment, CAQH maintenance, Medicare and Medicaid, hospital privileging, revalidations and expirables — tracked to the day.
- New-provider enrollment in 60–90 days, tracked daily
- CAQH, PECOS, NPPES and roster maintenance
- Expirables calendar so nothing lapses unannounced
Practice Auditing & Compliance
Pre- and post-payment chart audits, coding and billing reviews, HIPAA and OSHA assessments, and corrective action plans that hold up.
- Independent audit of coding, billing and documentation
- HIPAA, OSHA and program-integrity risk assessments
- Corrective action plans with measurable follow-up
Talk to someone who has run this before.
Thirty minutes with an operations lead who works this service every day. Bring your numbers if you have them; we will tell you what we see either way.
A 30-minute call with an operations lead. No obligation, no sales sequence, and we will say so if you do not need us.