Services
Revenue Cycle Management Services
Revenue cycle management connects every step that decides whether a practice gets paid: registration, eligibility, authorization, charge capture, coding, claims, posting, denials and patient collections. We run those steps as one process, measured against KPIs you agree with us up front.
- Front-end, mid-cycle and back-end work owned by one accountable team
- Problems traced back to the step that caused them, not just patched downstream
- KPIs reported on definitions agreed with you, so the numbers mean what they say
7+ yearsIn medical billing and revenue cycle management
Dedicated account managerYour main contact for billing questions
Multi-specialty teamBilling and coding across many specialties
Free billing auditNo patient data needed to get started
The three stages we manage
RCM is usually split into front-end, mid-cycle and back-end work. Gaps between the stages are where revenue is lost.
Front end: patient access
Registration accuracy, insurance capture, eligibility and benefits checks, and prior authorizations, so every claim starts with the right payer and an approval where one is needed.
Mid-cycle: charge integrity
Reconciling the appointment schedule against posted charges so no completed visit goes unbilled, plus coding review against the documentation.
Mid-cycle: claim production
Scrubbing, submission and rejection handling, with payer-specific edits maintained as payer rules change.
Back end: payment integrity
Posting remittances, reconciling deposits to the bank and checking paid amounts against contracted rates to catch underpayments.
Back end: denials and A/R
Working denials by root cause and following up open claims by payer, age and filing deadline.
Patient financial experience
Estimates, clear statements and payment plans that make the patient share of each bill easier to collect. Patient billing can be included in your engagement or left with your team.
From baseline to steady state
Taking over a revenue cycle is a project first, then a routine.
Step 1: Measure the baseline
We calculate your current KPIs from practice management reports, so later improvement is measured against your own starting point, not a generic benchmark.
Step 2: Agree who owns what
Front-desk tasks, provider tasks and our tasks are written down in a responsibility matrix, so nothing falls between your team and ours.
Step 3: Stabilize the backlog
Open denials, unbilled encounters and aging A/R are worked down first, prioritized by filing deadline and value.
Step 4: Run and review monthly
The cycle runs on a daily routine, and each month we review the KPIs with you and pick the next bottleneck to fix. The monthly review is held by video call with your account manager.
When full RCM makes sense
Billing is split across several people or vendors
When the front desk, a coder and an outside biller each own a piece, nobody owns the result. One accountable team fixes that.
Groups that have grown or merged
Multiple locations, tax IDs and fee schedules make it hard to see where revenue is lost without consistent reporting.
Practices without reliable numbers
If you cannot say what your days in A/R or denial rate are today, it is hard to tell whether billing is improving.
The KPIs we report on
Standard revenue cycle measures, defined the same way every month. Definitions vary between vendors, so we agree them with you before the first report.
| Measure | What it shows | How it is usually calculated |
|---|---|---|
| Days in A/R | How long, on average, it takes to turn a charge into cash. | Total A/R balance divided by average daily charges over a recent period, often 90 days. |
| Net collection rate | How much of the money you are contractually owed is actually collected. | Payments divided by charges minus contractual adjustments, for the same period. |
| First-pass resolution rate | How many claims are paid without any rework. | Claims paid on first submission divided by all claims adjudicated. |
| Denial rate | How often payers refuse claims at first adjudication. | Denied claims (or denied dollars) divided by claims (or dollars) adjudicated. |
| A/R over 90 days | How much money is at risk of becoming uncollectable. | A/R older than 90 days divided by total A/R. |
| Charge lag | How long completed work waits before it is billed. | Average days from date of service to claim submission. |
We do not quote industry benchmarks without a cited source; your own baseline is the comparison that matters.
Frequently asked questions
What is the difference between medical billing and revenue cycle management?
Medical billing covers the claim itself: building it, submitting it, posting the payment and following it up. Revenue cycle management also includes the steps before and around the claim, such as registration, eligibility, authorization, charge reconciliation and patient collections, and it measures the whole process with shared KPIs.
Do we have to outsource the whole revenue cycle?
No. Some practices keep registration and check-in in house and hand over everything after the visit; others outsource only the back end. The responsibility matrix agreed at the start makes the split explicit, whichever way you choose.
Which KPIs should a practice look at first?
Days in A/R, net collection rate, denial rate and the share of A/R over 90 days give a quick picture of cash speed, collection completeness, claim quality and risk. Charge lag is worth adding if providers are slow to close notes.
How do you know if RCM is actually working?
By comparing each month's KPIs with the baseline measured at the start, using the same definitions. If a measure stops improving, the monthly review looks for the step causing it.
What does our team still need to do?
Typically your staff keep scheduling and check-in, and providers close notes promptly and answer coding queries. Everything else is agreed in the responsibility matrix. This is our standard division of work, adjusted for each practice.
Related services and specialties
Related services
Medical Billing
Charge entry, claim scrubbing, submission, payment posting and follow-up handled by a dedicated billing team.
Learn more about Medical BillingDenial Management
Denials worked by reason code and root cause, with corrected claims and appeals filed inside payer deadlines.
Learn more about Denial Management
Specialties
Internal Medicine Billing
Adult chronic disease care: MDM-based E/M, chronic and principal care management, wellness visits, transitional care and risk adjustment documentation.
Learn more about Internal Medicine BillingCardiology Billing
Billing for echo, stress testing, cath lab and device monitoring, with professional and technical splits handled correctly.
Learn more about Cardiology BillingOrthopedic Billing
Surgical global periods, laterality and bilateral rules, fracture care, injections and bracing, plus work-injury claims routed to the right payer.
Learn more about Orthopedic Billing
Get your revenue cycle baseline
A free billing audit calculates your current KPIs from summary reports and shows which stage of the cycle is costing you most.