Effective billing management covers your entire revenue cycle — from front-end eligibility verification through final claim payment — so you collect more, faster, with fewer denials. End-to-end RCM with 96% clean claim rate and 24-day average AR.
Revenue cycle management (RCM) is the end-to-end financial process healthcare practices use to track, manage, and collect payment for clinical services — from the moment a patient schedules an appointment through final claim payment or write-off. A well-run revenue cycle operates with a clean claim rate above 95%, days in AR under 30, and a denial rate below 5%. Practices with poor RCM leave 10–20% of earned revenue uncollected every year.
Insurance eligibility verification before every encounter. Prior authorization management with proactive renewal tracking. Accurate patient registration and demographic capture that prevents back-end denials.
CPT, ICD-10, and HCPCS code review. Modifier accuracy. Charge capture reconciliation to ensure every billable service is coded and submitted — no unbilled encounters.
Claim scrubbing and submission. Same-day denial identification. Systematic AR follow-up. Payment posting and underpayment recovery. Patient billing and payment plans.
| KPI | Industry Average | Target (Best Practice) | Top Quartile |
|---|---|---|---|
| Days in AR | 35–50 days | <30 days | 24 days |
| Clean Claim Rate | 82–88% | >95% | 96%+ |
| Denial Rate | 10–15% | <5% | <4% |
| Net Collection Rate | 92–95% | >96% | 97–99% |
| Cost to Collect | 8–15% | <5% | 3–10% |
Benchmarks sourced from MGMA 2025, HFMA, and HIMSS industry surveys.
We analyze your current revenue cycle, identify the top 5 revenue leaks, and calculate your potential revenue recovery. Takes 15 minutes. No obligation.
Eligibility verification workflows integrated with your EHR. Prior auth tracking established for all active payers. Registration error patterns identified and corrected.
Charge capture reconciliation every week. Coding accuracy review for high-value or high-risk codes. Unbilled encounter report reviewed monthly.
All claims scrubbed and submitted within 24 hours of charge receipt. Electronic acknowledgment tracked. Rejected claims re-submitted same day.
Every denial categorized by root cause. Appeals filed within payer deadlines. Denial trends reported monthly with root cause recommendations to prevent recurrence.
Monthly RCM scorecards with all KPIs. Payer performance analysis. Underpayment recovery from contract variance. Continuous improvement recommendations.
BAA signed before work begins. Encrypted data. HIPAA-trained staff. Annual audits. We take your compliance as seriously as our own.
Look for percentage-of-collections pricing rather than flat fees — it ties the billing partner's revenue to yours. When you collect more, they earn more.
Look for a partner with deep revenue cycle experience across specialties — one that has seen every payer game and knows how to win them.
Ask prospective billing partners for their client retention rate and references. High performers keep clients through results — not contracts.
A free 15-minute RCM audit identifies your top revenue leaks and quantifies how much you're leaving on the table. No obligation.