Revenue Cycle Management Services for Hospitals and Large Groups
Revenue cycle management is every step from the first eligibility check to the last payment collected. We run it for hospitals, ERs, urgent care networks and large groups, with 95% of claims clean, claims out within 24 hours of charge entry, and denials worked within 48 hours.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026- 97%client retention
- 95%clean claim rate
- Since 2018billing for US practices
- 48 hrsto work each denial
Included with Our Billing
What every billing client gets.
- EHR or PM softwareFree for every billing client.
- No setup feeNo fee to set up your billing.
- Old A/R workedAt no extra fee.
- A dedicated account managerIncluded for every billing client.
- Patient billingPatient statements and patient billing calls, at no extra fee.
- Monthly performance reportsIncluded with your billing.
In short: revenue cycle management is the whole path from registration to payment, not just claim submission. We run the front end, mid cycle and back end for facilities and large groups, and you keep clinical documentation, charge master decisions and payer contract signatures.
What Does a Revenue Cycle Management Company Actually Do for a Hospital?
A revenue cycle management company takes over the work between a patient scheduling a visit and the last dollar of that visit being collected. For a hospital, ER or urgent care network that means registration checks, charge capture, coding, claim submission, payment posting, denials, patient balances and old receivables.
We run that cycle for hospitals, emergency departments and freestanding ERs, urgent care networks, large groups and health systems. Facility work goes out on the UB-04 institutional claim and physician work on the CMS-1500 professional claim, from one team and one workflow. Facility detail is on hospital and facility billing.
Revenue cycle management (RCM) is the full chain of steps that turns care delivered into cash received. It is wider than billing, which is the claim and follow-up part.
What Happens at the Front End of the Revenue Cycle?
The front end decides whether a claim can be paid. Most avoidable denials start here.
We run automated eligibility checks against the payer, flag coverage problems before or at the visit, and chase prior authorization where the payer requires it.
- Eligibility verification: active coverage, plan type, and out-of-network status confirmed against the payer.
- Prior authorization: requests, follow-up and the authorization number attached to the account.
- Credentialing: providers enrolled with each payer, so claims are not denied as out of network by mistake.
What Is the Mid Cycle, and Why Does Coding Sit in the Middle?
The mid cycle turns the clinical record into a claim: charge capture, coding, and edits that catch errors first.
Our AAPC and AHIMA certified coders read the record, assign codes and check them against payer rules. A claim then passes through multiple claim scrubbing rules before it leaves. We send claims within 24 hours of charge entry, and we report a 95% clean claim rate. A clean claim is one accepted and processed by the payer without being rejected or sent back for correction.
What We Check on a Facility Claim
On the UB-04 we check the bill type, revenue codes, patient status, condition and occurrence codes, authorization requirements and payer-specific rules. On the CMS-1500 we check the professional-side coding and modifiers.
See medical coding.
What Happens at the Back End: Payments, Denials and A/R?
The back end collects what the claim earned. That means posting payments, reconciling them to what the payer owed, working denials and following unpaid claims until they are resolved.
Payers return payment detail on the X12 835 electronic remittance advice, the HIPAA standard for claim payment and advice under 45 CFR 162.1602. We post from it, match each payment to the expected amount, and flag underpayments. We work denials within 48 hours. We recover 15 to 20% of revenue from denials and old A/R.
- Denial management: every denial worked within 48 hours, the reason code read, the claim corrected or appealed, and the cause traced back upstream.
- A/R recovery: unpaid and aged claims worked by age and dollar value, oldest dollars at risk first.
- Patient billing: statements, balance follow-up and payment plans after insurance has paid.
- Out-of-network billing and IDR: No Surprises Act open negotiation and federal Independent Dispute Resolution for underpaid claims.
Which of the 22 Services Sit Inside Revenue Cycle Management?
Most of our 22 services are parts of the revenue cycle. You can buy the whole cycle or a single piece of it.
| Stage | Services | What it protects |
|---|---|---|
| Front end | Eligibility verification, prior authorization, credentialing | Claims payable when they leave |
| Mid cycle | Medical coding, hospital and facility billing, professional medical billing | Accurate claims, sent quickly |
| Back end | Denial management, A/R recovery, patient billing, out-of-network billing and IDR | Earned revenue still unpaid |
The full list is on the services hub. Licensing, CCM and RPM billing, MIPS reporting, virtual assistants and scribes, records management, white-label billing and marketing sit outside the core cycle.
Which Parts of the Revenue Cycle Can Be Outsourced, and What Should Stay In-House?
Almost every administrative step can be outsourced. Decisions that depend on your clinicians or payers stay with you.
A few jobs can go either way, such as registration or clinical appeals. We set the split in the scope document before work starts.
How Does an RCM Partner Handle No Surprises Act Disputes?
An RCM partner works the dispute from the first underpayment to the final payment.
We handle it end to end: eligibility assessment, open negotiation, dispute submissions, deadline management, documentation validation and outcome tracking, under federal IDR and applicable state pathways, including Texas TDI.
What KPIs Show an RCM Partner Is Working?
Four numbers tell you most of it: clean claim rate, denial rate, days in A/R and net collection rate. Get each defined in writing.
| KPI | What it measures | What to watch for |
|---|---|---|
| Clean claim rate | Claims accepted by the payer without correction, as a share of claims sent | First-time acceptance, or eventually paid |
| Denial rate | Denied claims as a share of claims submitted, by payer and by reason code | Low because denials are written off |
| Days in A/R | Open receivables divided by average daily charges | Averages can hide old, large accounts |
| Net collection rate | Payments collected as a share of what was owed after contractual adjustments | Contract rate or billed charge as the base |
Our reported results are a 95% clean claim rate, claims sent within 24 hours of charge entry, denials worked within 48 hours, 15 to 20% of revenue recovered from denials and old A/R, and a 25% average revenue lift. You can model your own denial rate and days in A/R with the A/R days and denial rate calculator.
Talk to a Billing Lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.
What Reports and Dashboards Should an RCM Vendor Give You Each Month?
A monthly package should show where the money is, where it is stuck, and what to fix.
- Charges, payments and write-offs by payer.
- Clean claim rate and first-pass acceptance by payer.
- Denials by reason code, with dollars denied, dollars recovered and appeals pending.
- A/R aging by payer, with the largest open accounts listed.
- Out-of-network disputes: open, in negotiation, in IDR, and paid.
We agree the report format and schedule at kickoff and monitor performance against it.
Can an RCM Partner Work Inside Your Existing EHR and Clearinghouse?
Yes. We align each EHR, clearinghouse and payer portal workflow with verified team experience, standard claim validation, reconciliation controls and performance monitoring.
Billing clients also get EHR or PM software free, with no separate EHR subscription.
Claims travel as X12 837 transactions, which HIPAA adopts for institutional and professional claims under 45 CFR 162.1102. Your clearinghouse sends them and returns acceptance reports.
How Long Does It Take to Switch to an Outside RCM Partner?
It depends on your systems, payers and open accounts. We give a written timeline after we see your EHR, clearinghouse, payers and aging report.
Who Owns the Data and the Payer Relationships If You Leave?
You should. Your accounts, claim history and payer enrollments belong to your organization, and the contract should say so.
Get four things in writing: ownership of the account data, a usable data export at exit, a notice period, and a handover of open claims and denials with their deadlines.
What Should a Billing Company's BAA and HIPAA Controls Include?
A billing company that sees patient data is a business associate under HIPAA, and you need a written contract with it first. 45 CFR 164.502(e) requires a covered entity to document that satisfactory assurance in a written contract, and 45 CFR 164.504(e) lists what the contract must contain.
We sign a Business Associate Agreement with every client. HIPAA training and NDAs cover all staff, every system uses two-step login, backups are encrypted and automatic, and a dedicated compliance officer owns the program.
How Do You Compare Two RCM Proposals Fairly?
Put both vendors on the same scope, KPI definitions and exit terms, then compare total cost. A lower percentage can cost more if it excludes work you then do yourself.
- Scope: which stages, claim types and payers are included.
- Fee base: percent of collections on what, and whether it covers denial recoveries and old A/R.
- KPI definitions: how each vendor defines clean claim rate, denial rate and days in A/R.
- Reporting and exit: sample reports, data ownership, export and handover.
Billing is priced as a percent of collections. See pricing for the range.
What Is the Difference Between RCM and Medical Billing?
Medical billing is one part of revenue cycle management. Billing prepares and sends claims and follows them to payment, while RCM adds eligibility, authorization, coding, denials, patient balances and reporting.
A practice that only needs claims sent can buy professional medical billing. Hospitals and ER groups usually need the whole cycle.
How We Handle Revenue Cycle Management
We take the cycle in stages you choose, and we are measured on results you can check. Our team has billed for US practices since 2018.
We read your numbers, set the scope, sign a BAA and set up access. Then we run the stages you hand us, with automated eligibility checks and claim scrubbing before every claim leaves, denials worked within 48 hours, and a report on the KPIs above.
For the hospital view, see who we serve: hospitals. To talk through your cycle, book a call.
- 42 CFR 424.44 Time limits for filing claims · eCFR
- 45 CFR 162.1102 Standards for health care claims or equivalent encounter information transactions · eCFR
- 45 CFR 162.1602 Standards for health care EFT and remittance advice transaction · eCFR
- 45 CFR 164.502 Uses and disclosures of protected health information: general rules · eCFR
- 45 CFR 164.504 Uses and disclosures: organizational requirements · eCFR
We check every rule, code and deadline against the official source. See our editorial policy.
Who We Do This For
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What does a revenue cycle management company actually do for a hospital?
It runs the work between scheduling a visit and collecting the last dollar: eligibility checks, authorization, coding, claim submission, payment posting, denials, patient balances and old receivables. One team owns the account from registration to payment, including UB-04 and CMS-1500 claims.
02Which parts of the revenue cycle can be outsourced and which should stay in-house?
Eligibility, authorization, coding review, claims, posting, denials, A/R and patient statements can all be outsourced. Keep clinical documentation, charge master decisions, payer contract signatures and report review, because those depend on your clinicians and payers. The split goes in the scope document.
03How long does it take to switch to an outside RCM partner?
It depends on your systems, payers and open accounts, so ask for a written timeline after the vendor has seen your EHR, clearinghouse and aging report, and do not stop your old vendor until open claims have an owner. Expect scope, a signed BAA, access and a baseline first.
04What reports and dashboards should an RCM vendor give me each month?
At minimum: charges and payments by payer, clean claim rate, denials by reason code with dollars recovered, A/R aging by payer, out-of-network dispute status, and recommended upstream fixes. Each report should trace to claim-level detail. Ask for a sample report before signing.
05How is RCM priced: percent of collections or flat fee?
Most RCM billing is priced as a percent of collections, which ties the vendor's income to yours. Flat fees tend to exclude work such as denials. Compare what each fee covers, and whether it applies to old A/R. Our range is on the pricing page.
06What KPIs show an RCM partner is working (clean claim rate, days in A/R, denial rate)?
Track clean claim rate, denial rate, days in A/R and net collection rate, with each definition in writing. Our reported results are a 95% clean claim rate, claims sent within 24 hours of charge entry, and denials worked within 48 hours.
07Can an RCM partner work inside our existing EHR and clearinghouse?
Yes. You do not need to replace your EHR or clearinghouse. We align each EHR, clearinghouse and payer portal workflow with verified team experience, standard claim validation, reconciliation controls and performance monitoring, and we work from your clearinghouse reports and 835 remittances.
08Who owns the data and the payer relationships if you leave?
You should. Account data, claim history, payer contracts and enrollments belong to your organization. Before signing, get ownership, a usable data export, a notice period and a handover of open claims and denials with their deadlines written into the contract.
09How do you handle both facility (UB-04) and professional (CMS-1500) claims in one workflow?
Both claim types are built from the same account by one team. The UB-04 is checked for bill type, revenue codes, patient status, condition and occurrence codes, authorization requirements and payer rules. The CMS-1500 is checked for professional-side coding and modifiers.
10How does an RCM partner handle No Surprises Act disputes?
It works the dispute from the first underpayment to final payment: eligibility assessment, open negotiation, dispute submissions, deadline management, documentation validation and outcome tracking under federal IDR and applicable state pathways, including Texas TDI. Our process is described on the out-of-network billing and IDR service page.
11What should a billing company's BAA and HIPAA controls include?
A written Business Associate Agreement meeting 45 CFR 164.504(e), plus staff HIPAA training, NDAs, two-step login, encrypted backups and a named compliance officer. We sign a BAA with every client and use all of those controls. Ask any vendor for the same list in writing.
Talk to a Billing Lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.