Service 01 — Revenue Cycle Management
Revenue cycle, end to end
From the moment an appointment is booked to the day the balance hits zero, we own the workflow: eligibility, coding, submission, denial resolution, posting and patient balances.
Capabilities
What the team owns
Eligibility & prior auth
Real-time benefit verification and authorisation tracking before the patient is seen, so front-end errors never reach the claim.
Medical coding
Certified coders across specialties — CPT, ICD-10-CM, HCPCS and modifier accuracy with documentation review.
Claim scrubbing & submission
Payer-specific edits applied before submission, with clearinghouse rejections resolved same day.
Denial management
Every denial coded to a root cause, appealed with supporting documentation, and fed back into front-end fixes.
Payment posting & AR
ERA/EOB posting, underpayment detection against contracted rates, and disciplined AR follow-up by aging bucket.
Analytics & reporting
Clean-claim rate, days in AR, denial mix, net collection rate and payer performance in one recurring review.
Scope
Included in every engagement
Front end
- Patient demographics and insurance capture QA
- Real-time eligibility and benefits verification
- Prior authorisation initiation and tracking
- Charge entry and charge capture reconciliation
Mid cycle
- Specialty-specific CPT / ICD-10 coding
- Documentation and medical-necessity review
- Payer-rule claim scrubbing and edits
- Primary, secondary and tertiary submission
Back end
- ERA and manual payment posting
- Denial categorisation, appeal and re-submission
- Contract-rate variance and underpayment recovery
- Patient statements, balances and support
Outcomes
What changes for you
Cleaner claims
Fewer rejections at the clearinghouse because errors are caught before submission rather than after denial.
Shorter AR
Aging buckets are worked on a schedule, so cash arrives in weeks rather than quarters.
Fewer surprises
Monthly reviews show exactly where revenue leaked and what has been changed to stop it.
Send us one month of denials
We will categorise them, show you the root causes and outline what we would change first.