Revenue Cycle Management Company
Built for Complex Providers

Most prior auth denials trace back to three things: missing clinical documentation, submitting to the wrong payer portal, and no follow-up until the claim is already denied. The fix is checking auth requirements before the visit is booked, submitting with the clinical criteria the payer actually scores against, and tracking every pending auth to approval instead of waiting. Our prior authorization services handle payer portals, peer-to-peer scheduling, and status follow-up so procedures are not delayed and revenue is not written off.

Roughly a quarter of denials start at the front desk: expired coverage, wrong plan on file, missing secondary insurance, or a patient who switched payers since the last visit. These become eligibility denials, coordination of benefits denials, or surprise patient balances nobody can collect. Running real-time eligibility and benefits verification before every encounter catches coverage changes, copay and deductible amounts, and plan limits while the patient can still be told what they owe.

Payer enrollment typically runs 90 to 180 days, and a provider who is not credentialed cannot bill, so every week of delay is unbilled revenue. New practices are hit hardest because they need CAQH setup, NPI and taxonomy, Medicare and Medicaid enrollment, and commercial contracts running in parallel. We manage provider credentialing and payer enrollment end to end, including credentialing for new clinicians, revalidations, and roster maintenance so start dates and billing dates line up.

Safety-net billing runs on encounter-based reimbursement rather than fee-for-service. FQHCs bill a PPS rate, RHCs bill an all-inclusive rate, and both have wrap-around payments, sliding fee scale patients, 340B considerations, and grant reporting that standard billing teams routinely mishandle. We build RCM specifically for FQHCs, rural health clinics, and community health centers, including qualifying visit rules, same-day visit billing, and UDS-aligned reporting.

Working denials one claim at a time never fixes the underlying leak. We segment A/R by payer, denial reason code, and age, then fix the root cause upstream while appealing what is recoverable. That means CARC and RARC analysis, timely filing triage, and appeals with the documentation the payer needs the first time. Practices moving to our A/R and denial management services typically see days in A/R drop and aged buckets over 90 days shrink because the same denial stops recurring.

Yes, in both directions. Undercoding gives away work you already performed, and overcoding invites audits and takebacks. Missed modifiers, wrong E&M level, unbundled CPT codes, and specificity gaps in ICD-10 quietly reduce reimbursement on every claim. Our certified coders handle medical coding and coding audits across specialties, with regular chart audits so the coding matches the documentation and the documentation supports the code.

Yes. High-volume, unscheduled care has its own problems: incomplete registration, self-pay-heavy patient mix, facility versus professional splits, and observation versus inpatient status. Critical access hospitals bill under cost-based reimbursement with method I and method II election rules, and emergency department billing is heavily scrutinized on E&M leveling and medical necessity. We staff these separately from routine clinic billing because the payer behavior is different.

Patient responsibility keeps rising with high-deductible plans, and most of the loss happens because balances are communicated late and vaguely. Collecting improves when the estimate is given before or at the visit, the statement is readable, and payment plans exist for larger balances. Our self-pay collection and patient invoicing covers point-of-service estimates, clear statements, and payment plans so patients are not surprised and balances are resolved earlier.

In-house makes sense when volume is steady and you have depth on the team. It breaks down when a biller leaves, a payer changes rules, or growth outpaces staffing, because A/R quietly ages while nobody has capacity. Outsourcing converts a fixed staffing cost into a variable one and adds specialty coding, credentialing, and denial expertise you would otherwise hire separately. Our RCM solutions can run the full revenue cycle or just the segment that is leaking, such as A/R cleanup, coding, or credentialing.

We staff by specialty because payer rules are not interchangeable. That includes behavioral health with time-based and telehealth coding, cardiology, radiology with professional and technical splits, orthopedics with global surgical periods, dermatology, neurology, pain management, nephrology and dialysis, retina with buy-and-bill drugs, dental, chiropractic, ambulatory surgery, and skilled nursing.