Revenue Cycle Management Services

Before the visit: eligibility verification

Coverage gets confirmed on every date of service — active status, plan type, network standing, patient responsibility, and prior authorization requirements — with demographics matched against payer records so identity mismatches do not generate rejections later. Problems come back to your scheduler before the patient arrives, which is the only point where a coverage issue is cheap to fix. For practices whose denials cluster in registration and eligibility categories, this one service moves the numbers fastest.

Turning care into a claim: coding and billing

Certified coders assign CPT, ICD-10-CM, and HCPCS codes based on what the documentation supports, validate NCCI pairings and modifiers, and query providers when a note cannot carry the service billed. Billing then enters charges daily, scrubs against payer-specific edits, and files within 48 hours. Remittances are posted against expected contract rates so underpayments surface instead of quietly closing, and patient statements go out only after every payer has finalized.

After the denial: A/R follow-up and denial management

Open claims are triaged by value, payer behavior, and time remaining before appeal and filing deadlines close, then researched to actual root cause rather than the code on the remittance. Correctable claims are fixed and resubmitted; wrongful denials get appeals citing payer policy with supporting records attached. Every denial is categorized so you can see which upstream process is generating them and stop paying to rework the same problem each month.

Keeping providers billable: credentialing and contracting

Payer enrollment applications, CAQH profile maintenance and attestation, NPI and NPPES accuracy, re-credentialing cycles, and expirable document tracking across every provider and every payer. Group changes — a new physician, a location move, a tax ID change — get handled before they generate denials. A lapsed credential is one of the few revenue problems where nothing is wrong with the claim and nothing can be done to make it pay.

Closing the books: credit balance resolution

Credit balances get reconciled account by account to separate genuine overpayments from posting artifacts, which is most of them. Misapplied transactions are corrected and reclassified; real overpayments are refunded or offset per payer procedure with full supporting documentation. Recurring causes are named in the reporting so the backlog does not rebuild. This clears both a compliance exposure and a distortion in your financial reporting at the same time.

Specialty coverage

We work across ambulance transportation, anesthesia, cardiology, chiropractic, dental, dermatology, durable medical equipment, emergency medicine, family practice, general surgery, hospital billing, internal medicine, mental health, OB/GYN, oncology, optometry, orthopedics, pain management, pediatrics, physical therapy, podiatry, radiology, skilled nursing facilities, urology, and wound care. Coders and billers are assigned by specialty rather than pooled, because payer rules and documentation conventions differ enough between them that generalist staffing shows up directly in your denial rate.