Indiquer
Our Proven
Revenue Cycle Process
A systematic, data-driven approach that transforms your revenue cycle from claim submission to payment collection—optimizing every touchpoint for maximum efficiency and profitability.
Clean Claim Rate
First-pass accuracy
Revenue Boost
Average increase
Claim Turnaround
Average processing
Denial Recovery
Successful appeals
The Complete Journey
From patient arrival to final payment—a seamless, optimized revenue cycle
Verification
Eligibility Check
Coding
Accurate Coding
Submission
Fast Filing
Payment
Posting & Recon
Follow-up
A/R Management
How We Optimize Your Revenue Cycle
Every step meticulously designed to maximize revenue and minimize delays
Patient Registration & Insurance Verification
Foundation of Clean Claims
We start by capturing accurate patient demographics and verifying insurance eligibility in real-time, 24-48 hours before appointments. This proactive approach prevents 90% of potential claim denials before they occur.
What We Verify:
- • Real-time insurance eligibility (EDI 270/271)
- • Active coverage status and effective dates
- • Benefits coverage analysis for planned procedures
- • Patient demographic data accuracy
- • Co-pay, deductible, and coinsurance amounts
- • Prior authorization requirements
Impact on Your Practice:
- • 40% reduction in eligibility-related denials
- • Improved patient satisfaction with cost transparency
- • Reduced bad debt and write-offs
- • Faster claim adjudication
- • Fewer appointment cancellations
- • Better cash flow predictability
Best Practice:
Verifying eligibility 24-48 hours before appointments gives you time to resolve coverage issues, collect patient responsibilities upfront, and prevent surprises at check-in.
Expert Medical Coding & Documentation
Precision Meets Compliance
Our AAPC-certified coders translate clinical documentation into accurate ICD-10, CPT, and HCPCS codes within 24 hours of service. Every code is reviewed for accuracy, medical necessity, and compliance before submission.
Our Coding Expertise:
- • ICD-10-CM diagnosis coding (7th character specificity)
- • CPT procedural coding & E/M level selection
- • HCPCS Level II for supplies & services
- • Modifier application & sequencing (25, 59, etc.)
- • DRG assignment for inpatient services
- • Medical necessity justification
Quality Assurance Process:
- • Multi-level coding review & audit
- • Compliance with CMS & payer guidelines
- • Regular internal coding audits
- • Continuing education for all coders
- • Specialty-specific expertise
- • Documentation improvement feedback
Revenue Leakage Alert:
Undercoding costs practices an average of 15-20% in lost revenue annually. Our expert coders ensure every service is captured appropriately while maintaining full compliance with regulations.
Charge Entry & Electronic Claims Submission
Speed Meets Accuracy
We capture charges accurately and submit clean claims electronically within 24-48 hours of service. Our advanced scrubbing technology catches errors before submission, ensuring maximum first-pass acceptance rates.
Our Submission Process:
- • Automated charge capture from EMR/PM systems
- • Comprehensive claim scrubbing (pre-submission)
- • Electronic submission via clearinghouse (EDI 837)
- • Paper claim processing when required
- • Secondary & tertiary payer coordination
- • Attachment management & supporting documentation
Pre-Submission Quality Checks:
- • Duplicate claim detection
- • Payer-specific requirements validation
- • NPI & taxonomy verification
- • Fee schedule accuracy check
- • Place of service code validation
- • Real-time submission tracking & confirmation
Speed = Cash Flow:
Claims submitted within 48 hours get paid 30-40% faster on average. Our streamlined process ensures your claims are processed quickly while maintaining 98%+ clean claim rates.
Payment Posting & Reconciliation
Every Dollar Accounted For
We meticulously post all payments, adjustments, and denials within 24 hours of receipt. Daily reconciliation ensures complete financial accuracy and immediately flags any discrepancies or underpayments for follow-up.
What We Post:
- • Insurance payments (ERA/EOB processing)
- • Patient payments, copays & deductibles
- • Contractual adjustments & write-offs
- • Denials with reason codes
- • Secondary & tertiary payer payments
- • Refunds, credits & reversals
Daily Reconciliation:
- • Payment batch reconciliation
- • Fee schedule verification & comparison
- • Underpayment identification
- • Variance analysis & reporting
- • Month-end closing procedures
- • Bank deposit matching
Hidden Revenue Recovery:
Our meticulous reconciliation process identifies underpayments and contract discrepancies that most practices miss, recovering an average of 3-5% in additional revenue annually.
Proactive Denial Management & Appeals
We Fight For Every Dollar
Denials are addressed immediately—not left to accumulate. Our dedicated denial management specialists analyze root causes, file systematic appeals within timely filing limits, and implement preventive measures to reduce future denials.
Our Approach:
- • Real-time denial identification & categorization
- • Root cause analysis by denial type
- • Systematic appeal letter preparation
- • Clinical documentation review & augmentation
- • Peer-to-peer review coordination
- • Second & third-level appeals when necessary
Prevention Strategy:
- • Denial trending & pattern analysis
- • Payer-specific issue identification
- • Process improvement recommendations
- • Provider & staff education
- • Documentation improvement programs
- • Proactive denial prevention protocols
Industry-Leading Success Rate:
We successfully overturn 85%+ of denied claims through our systematic appeal process. Most practices recover less than 50% because they lack dedicated resources and expertise.
Aggressive A/R Follow-up & Collections
Relentless Revenue Recovery
We actively manage your accounts receivable with systematic daily follow-up on all outstanding claims. No claim is left behind, and every dollar is pursued until collected or determined uncollectible.
Daily Follow-up Activities:
- • A/R aging review (30/60/90/120+ days)
- • Insurance payer phone follow-up
- • Payer portal claim status checks
- • Patient statement generation & mailing
- • Payment plan arrangement & tracking
- • Collections agency referrals when appropriate
Performance Monitoring:
- • Days in A/R tracking & benchmarking
- • Collection rate analysis by payer
- • Aging bucket trending
- • Payer performance scorecards
- • Write-off analysis & prevention
- • Cash flow forecasting & projection
Time Equals Money:
For every 10-day reduction in A/R, practices see a 2-3% increase in annual revenue. We typically reduce days in A/R by 15-20 days within the first 90 days of engagement.
Comprehensive Reporting & Analytics
Data-Driven Decision Making
Knowledge is power. We provide detailed, customized reports and real-time dashboards that give you complete visibility into your practice's financial health and identify opportunities for revenue optimization.
Standard Reports:
- • Monthly revenue analysis & trends
- • A/R aging summaries by payer
- • Payer performance & reimbursement rates
- • Denial trending & root cause analysis
- • Collection rate metrics & benchmarks
- • Provider productivity & charge analysis
Advanced Analytics:
- • Real-time KPI dashboards
- • Procedure-level profitability analysis
- • Payer contract compliance tracking
- • Benchmark comparisons (specialty-specific)
- • Revenue leakage identification
- • Predictive cash flow modeling
Actionable Intelligence:
Our reports don't just show numbers—they provide clear, actionable recommendations. You'll know exactly where to focus efforts for maximum impact on your bottom line.
Continuous Improvement & Optimization
Never Stop Improving
Your revenue cycle is never "finished." We continuously analyze performance data, identify improvement opportunities, and implement optimization strategies to keep your practice ahead of industry changes and maximize financial performance.
Ongoing Optimization:
- • Monthly performance review meetings
- • Process efficiency analysis
- • Payer policy update monitoring
- • Fee schedule optimization recommendations
- • Technology upgrades & integration
- • Regulatory compliance monitoring
Education & Training:
- • Provider documentation training
- • Staff best practices workshops
- • Industry updates & changes briefings
- • Compliance training sessions
- • New technology implementation support
- • Quarterly performance reviews
Partnership Approach:
We're not just a vendor—we're your strategic partner in growth. Your dedicated account manager proactively identifies opportunities and works with you to implement improvements that drive sustainable revenue growth.
Why Our Process Works
The key differentiators that make our revenue cycle process superior
Expert Team
AAPC-certified coders, experienced billing specialists, and dedicated account managers with decades of combined healthcare revenue cycle expertise.
Advanced Technology
Cutting-edge RCM software, AI-powered claim scrubbing, automated workflows, and real-time analytics that maximize efficiency and accuracy.
Speed & Precision
24-48 hour claim submission, same-day payment posting, and immediate denial action ensure your revenue cycle moves at maximum velocity.
Complete Transparency
Real-time dashboards, comprehensive monthly reports, and regular performance meetings give you full visibility into every aspect of your revenue cycle.
Compliance First
HIPAA-compliant processes, regular coding audits, and adherence to all CMS and payer guidelines protect your practice from audit risks.
Results-Driven
We focus on what matters most—your bottom line. Every process improvement, every optimization is designed to increase your revenue and reduce costs.
Ready to Optimize Your Revenue Cycle?
Let's discuss how our proven process can transform your practice's financial performance and give you the peace of mind you deserve.
