End-to-End Revenue Cycle Management
We provide modular and integrated solutions tailored to Multi-Specialty Clinics, Hospitals, and individual practitioners across the United States.
Accurate medical coding is the foundation of a healthy RCM. Our credentialed coders (AAPC/AHIMA) stay updated on annual NCCI edits, ICD-10-CM/PCS, CPT, and HCPCS changes to ensure compliant optimization of coding metrics. We meticulously translate patient records into universal codes, abstracting the highest possible specificity to prevent unbundling or down-coding.
We handle prompt charge capture, comprehensive scrubbing, and EDI batch transmissions through premier clearinghouses. Our automated rules engine intercepts errors before claims leave your system, ensuring an industry-leading >98% First Pass Acceptance Rate (FPAR). This proactive approach accelerates clean claim submission.
Accounts Receivable management is the backbone of practice cash flows. We systematically track unpaid claims over 30, 60, 90, and 120+ days aging buckets. Our relentless follow-up teams utilize direct payer relations and IVR portals to secure estimated payment dates, drastically lowering Days in A/R and recovering long-lost dollars.
Denials are the largest source of revenue leakage in modern healthcare. Our dedicated denial management team investigates the root cause of every rejected claim via strict ANSI remark code analysis. We correct, appeal, and re-submit denied claims, while building preventive edits to stop future occurrences.
Incorrect or expired data causes over 30% of initial denials. We perform proactive Verification of Benefits (VOB) prior to patient visits. By confirming coverage limits before services are rendered, we secure pre-authorizations and inform your front-desk exact amounts to collect upfront.
Precision in payment posting provides an accurate view of financial performance. We capture revenue data by processing Electronic Remittance Advices (ERA) automatically and parsing manual Explanation of Benefits (EOB) documents with line-item accuracy to ensure compliance with contracted rates.
High volume, fast-paced environments require exceptionally rapid billing cycles. We understand the nuances of urgent care triage, split-billing, point-of-care testing, and preventive medicine rules applied by Medicare and top commercial payers.
Orthopedic billing is notoriously complex due to high-value surgical interventions. Our specialized certified orthopedic coders perfectly navigate the myriad of inclusive vs. exclusive procedures to prevent costly bundle denials and ensure proper physician reimbursement.
Interventional cardiovascular procedures involve some of the highest scrutiny by auditors. We manage intricate component billing, separating professional (PC) and technical (TC) work precisely. Our experts strictly minimize your compliance risk while maximizing authorized payouts.
From standard X-rays to advanced MRI and CT contrast studies, high-volume imaging centers rely on us to capture every charge. We enforce strict front-end checks to ensure the referring physician's NPI is valid, preventing frustrating top-level Medicare rejections.
Navigating the distinct differences between medical and dental insurance is critical for oral surgeons and complex dental practices. We efficiently manage pre-determinations and cross-code claims so your practice secures accurate and timely reimbursement.