Healthcare Revenue Cycle Management Services

Healthcare Revenue Cycle Management Services

At The Outsourcing Medical Billing, we provide Revenue Cycle Management (RCM) solutions specifically designed for healthcare organizations dealing with shrinking margins, growing payer complexity, and administrative burden. Whether you’re running a small group practice, managing a specialty clinic, or scaling a multi-location hospital system, our services are designed to identify gaps in your revenue cycle and correct them — early, systematically, and accurately.

OUR SERVICES

We work with providers globally who are tired of rising denials, inconsistent cash flow, underpaid claims, and long DSO (Days Sales Outstanding) cycles. Our goal is simple: plug revenue leaks and reduce dependency on reactive billing cycles.

Charge Capture & Coding Audit

  • Clean data in means clean cash out. We audit coding accuracy down to CPT and ICD-10 level.
  • Use of certified coders with domain knowledge in surgical, diagnostic, and high-cost procedural billing.
  • Flagging mismatches between clinical documentation and billing codes.

Outcome: 15–20% reduction in first-pass denial rates over 3 months.

1. Charge Capture & Coding Audit
2. Claim Submission (Clean Claims Focus)

Claim Submission (Clean Claims Focus)

  • Payer-specific edits run through automated pre-check tools.
  • 24–36 hour claim turnaround from documentation receipt.
  • 98%+ first-pass acceptance across top 10 payers globally.

Outcome: Improves reimbursement timelines, reduces rework load for your staff.

Accounts Receivable Management

  • Aggressive AR follow-up protocols: stratified by payer, aging bucket, and claim value.
  • Dedicated AR team uses denial reason codes to assign next actions (appeal, recode, rebill).
  • Target: Keep AR over 90 days under 10% of total AR.

Outcome: Increased cash flow consistency and better forecasting accuracy.

Denial Management & Root-Cause Reporting

  • Every denial logged, categorized, and tracked by frequency.
  • Monthly feedback loop to your clinical and admin staff to prevent repeat issues.
  • Appeals are handled with full documentation support.

Outcome: 30–50% fewer repeat denials within 60 days.

Payment Posting & Reconciliation

  • ERA and manual EOB postings handled daily.
  • Variance tracking built-in to flag underpaid claims.
  • Patient balance statements issued weekly.

Outcome: Eliminates revenue slippage from unnoticed underpayments.

4. Denial Management & Root-Cause Reporting
6. RCM Analytics & Payer Behavior Reporting

RCM Analytics & Payer Behavior Reporting

  • Real-time dashboarding with payer trends, denial mapping, CPT-level revenue tracking.
  • Monthly performance scorecard delivered with actionable data.

Outcome: Better strategic decisions based on quantifiable payer behavior.

How We Work With You

  • System Integration: We integrate with your EHR/EMR (Athenahealth, Kareo, Epic, DrChrono, etc.) or handle uploads via secure FTP/SFTP.
  • Process Mapping: A dedicated transition team defines every handoff — from charge entry to payment reconciliation.
  • Custom SOPs: We don’t replicate workflows. We document, align, and enhance them.

Why You Need This Now

Delays in clean claims, slow AR recovery, and a reactive billing model compound losses over time. You’re not just leaving money on the table — you’re inviting administrative chaos.

In an environment where:

  • Average denial rates have hit 10%+
  • 35% of denied claims are never reworked
  • Medicare reimbursements continue to drop

         a robust revenue cycle framework isn’t optional — it’s                           essential for survival.

Why You Need This Now

What You’ll Notice Within the First 30 Days

  • Consistent cash inflows from reduced DSO
  • Less time spent by your team chasing old claims
  • Drop in claim corrections and resubmissions
  • Transparent reporting that doesn’t require a finance degree to interpret

Frequently Asked Questions

 We maintain a constantly updated database of payer rules, prior authorization logic, and documentation protocols. All claims pass through an automated rule-engine before submission.

 Yes. We support integration with over 25 major systems including Epic, Kareo, Athenahealth, AdvancedMD, and can also work via manual data transfer protocols when needed.

 Each denial is categorized (CO, PR, OA, PI, etc.), analyzed for root cause, and queued for appropriate action: recoding, rebilling, appeal with supporting documentation, or patient contact (if required).

 You’ll get access to a real-time dashboard showing key metrics: claim status, AR aging, denial rates, payer mix, revenue by CPT, etc. A monthly call reviews trends and issues.

 Yes. We handle both paper and electronic statements, offer call-center follow-ups, and support secure payment portals if needed.

Want to Talk?

If your internal team is stretched, cash flow is unpredictable, or denials are eating into your margins — this is built for you.

We’ll show you how we reduce leakage, manage complexity, and improve financial control — using your data, not assumptions.