Revenue cycle management that follows every claim to payment
We run the work between the appointment and the deposit: eligibility, coding review, claims, payment posting, denials and A/R follow-up. Inside your systems, under a signed BAA.
Where practice revenue actually leaks
Most lost revenue isn't one big mistake. It's small, repeatable misses that nobody has time to chase.
A policy that changed since the last visit. A missing modifier. A prior authorization that expired. A denial that sat in a work queue for 60 days, then past the payer's appeal window. Each one is small. Together they decide whether your practice gets paid for the care it delivers.
We fix the process first, then work the queue every day, so the same miss doesn't happen twice.
What we handle, start to finish
Take the whole cycle off your plate, or hand us the stage that hurts most. Every task happens in your systems, with your rules.
Before the visit
- Insurance eligibility and benefits checks
- Demographic and registration review
- Prior authorization requests and tracking
- Patient cost estimates your front desk can share, including good faith estimates for uninsured and self-pay patients (CMS)
Claim to payer
- Charge entry and charge capture reconciliation
- Coding review: CPT, ICD-10-CM, HCPCS and modifiers
- Claim scrubbing against payer rules and NCCI edits
- Electronic submission and clearinghouse rejections
Payment and follow-up
- ERA and EOB payment posting and reconciliation
- Denial management, corrected claims and appeals
- A/R follow-up by payer and aging bucket
- Patient statements and balance questions
How it works
A staged handoff, so nothing stops while we take over.
Revenue review
We look at aging A/R, denial reasons and payer mix, and agree on what to fix first.
BAA and access
Signed BAA, then named accounts in your EHR, PM and clearinghouse.
Backlog first
Old denials and aging claims get worked by value and appeal deadline.
Daily cycle
Eligibility, charges, claims, posting and follow-up, every business day.
Monthly review
A plain-English report and a call on trends, fixes and next steps.
What you get every month
Visibility you can act on, without logging in to five portals.
KPI report
Days in A/R, clean claim rate, denial rate by reason and net collection rate, with trend lines and what we are doing about them.
Denial log
Every denial with its reason code, root cause, action taken and outcome.
A/R work plan
Open claims grouped by payer and age, prioritized by dollars and filing deadlines.
Payer notes
A living playbook of each payer's quirks, so fixes stick even when staff change.
A named contact
One person who knows your practice and answers within one business day.
Written procedures
Documented handoffs between your front desk and our team.
Denials: fix the cause, not just the claim
A denied claim has two problems: the money on that claim, and the process that produced it. We work both. Each denial is categorized by reason (eligibility, authorization, coding, timely filing, medical necessity, duplicate, bundling). The claim gets corrected and resubmitted or appealed with documentation. Then the pattern goes into the monthly report with a specific fix, such as an eligibility check moved earlier, a payer rule added to the scrubber, or a documentation tip for a provider.
Who it's for
- Independent and small group practices that bill their own claims
- Practices whose biller left, or who are carrying a backlog
- New practices setting up billing for the first time
- Groups that want an outside team to work denials and old A/R
Systems we work in
We work in your existing EHR, practice management system and clearinghouse, for example athenahealth, eClinicalWorks, Tebra, AdvancedMD, NextGen, DrChrono, ModMed, Practice Fusion, Availity, Office Ally or Waystar. Using something else? Tell us.
Product names are trademarks of their owners; listed for compatibility, not endorsement.
Your money stays with you
Insurance payments deposit directly into your practice's bank account, and patient payments go through your own merchant account. We post and reconcile them. We never hold, route or touch your revenue.
Pricing
Every RCM quote is written and specific to your practice, based on claim volume, specialty, payer mix and which stages you hand off. We agree on the fee structure up front; no surprises on the invoice.
Want the full picture first? Read our practical guide to revenue cycle management.
Revenue cycle management questions
Straight answers. If yours isn't here, email hello@claimcoders.com.
What is the difference between medical billing and revenue cycle management?
Medical billing is the claims part: coding, submitting and posting. Revenue cycle management covers the whole path from scheduling and eligibility to the final patient payment, including denials, A/R follow-up and reporting.
Will you work our old A/R and past denials?
Yes. We sort the backlog by dollar value and by each payer's filing and appeal deadlines, then work the claims that can still be recovered first.
How do you handle denials?
Every denial is logged with its reason code and root cause. We correct and resubmit, or appeal with documentation, then fix the upstream step that caused it, whether that is eligibility, coding or a payer rule.
Do you contact our patients about balances?
We send statements and answer balance questions on your behalf, using scripts you approve. We are not a collection agency and do not take accounts to collections.
Who gets the insurance payments?
Your practice does. Payers deposit directly into your bank account. We post and reconcile the payments but never hold your money.
Which KPIs will you report?
At minimum: days in A/R, A/R over 90 days, clean claim rate, denial rate by reason, first-pass resolution and net collection rate, with trends and what we are doing about each one.
Find out where your claims stall.
Tell us your specialty, systems and the A/R problem you would fix first. We reply within one business day.