End-to-End Revenue Cycle Management (RCM)
Full-service RCM: eligibility, coding, claims, denial appeals & A/R recovery. Cut days in A/R below 30 and grow monthly collections.
SERVICES
B2B Healthcare Support Services That Protect Your Revenue
End-to-end healthcare support: medical billing, RCM, credentialing & denial management — built for independent practices, group clinics, and ambulatory surgery centers.
THE FULL REVENUE ENGINE
One partner. Every revenue touchpoint.
Specialists, systems, and accountability across the complete patient-to-payment journey.
Medical Billing & Claims Management
Outsource medical billing to certified specialists. Faster payments, fewer rejections, transparent reporting. Serving practices of every size.
Medical Coding & Compliance Audits
Specialty-certified coders and compliance audits that stop revenue leakage and reduce audit risk. Accurate ICD-10, CPT & modifier usage.
Provider Credentialing & Payer Enrollment
CAQH, PECOS & payer enrollment handled end to end. Get providers credentialed faster and start billing sooner. Free credentialing review.
Denial Management & A/R Recovery
Recover lost revenue from denied claims and aging A/R. Certified specialists work denials systematically with payer-specific appeal strategies.
Chronic Care Management (CCM) & Remote Patient Monitoring (RPM)
Turnkey CCM & RPM programs: enrollment, documentation & Medicare billing (99490, 99453–99458). Add recurring revenue without adding staff.
Practice Management & Staff Augmentation
Cross-trained billing support that keeps claims moving when staff turn over, take PTO, or get pulled into patient-facing work.
Payer Contract Negotiation & Fee Schedule Review
Stop accepting underpayment. Expert payer contract analysis and negotiation that lifts reimbursement rates across your top payers.
MIPS / MACRA Reporting & Value-Based Care
Full-service MIPS reporting and value-based care support. Maximize your quality score and avoid Medicare payment penalties.
Healthcare Digital Marketing & Provider SEO
Verified Google Business Profiles, patient-review strategy, and local SEO so your services show up when patients in your area search for care.
SERVICE
End-to-End Revenue Cycle Management That Pays You Faster
Full-service RCM: eligibility, coding, claims, denial appeals & A/R recovery. Cut days in A/R below 30 and grow monthly collections.
What's included
- Pre-encounter eligibility & benefits verification
- Point-of-service collections & charge capture
- Claim scrubbing & clean claim submission
- Real-time denial management & appeals
- Payment posting, A/R monitoring & patient balance follow-up
- Transparent monthly RCM reporting
SERVICE
Medical Billing Services Built for Independent Practices
Outsource medical billing to certified specialists. Faster payments, fewer rejections, transparent reporting. Serving practices of every size.
What's included
- ICD-10, CPT & HCPCS claim preparation
- Electronic claim submission & clearinghouse management
- Payment posting & reconciliation
- Patient statements & balance follow-up
- Aging A/R follow-up and recovery
SERVICE
Certified Medical Coding That Survives Any Audit
Specialty-certified coders and compliance audits that stop revenue leakage and reduce audit risk. Accurate ICD-10, CPT & modifier usage.
What's included
- AAPC / AHIMA certified specialty coders
- Chart audits & documentation review
- Modifier accuracy (-25, -59, X{EPSU}, -RT/-LT, -76, -50)
- NCCI edit & bundling review
- Coding compliance & audit-readiness programs
SERVICE
Provider Credentialing Without the Bottlenecks
CAQH, PECOS & payer enrollment handled end to end. Get providers credentialed faster and start billing sooner. Free credentialing review.
What's included
- CAQH Pro-View profile creation & attestation
- Medicare PECOS & Medicaid enrollment
- Commercial payer enrollment & contracting
- Recredentialing calendars & expiration tracking
- Monthly OIG & SAM exclusion screening
SERVICE
Turn Denied Claims Into Collected Revenue
Recover lost revenue from denied claims and aging A/R. Certified specialists work denials systematically with payer-specific appeal strategies.
What's included
- Denial root-cause analysis by CARC code
- Corrected claims & electronic replacements (CO-16, claim frequency 7)
- Clinical appeals with operative notes & EOBs
- Timely filing protection & proof of submission
- Aging A/R prioritization over 60/90 days
SERVICE
Add Recurring Revenue With Turnkey CCM & RPM
Turnkey CCM & RPM programs: enrollment, documentation & Medicare billing (99490, 99453–99458). Add recurring revenue without adding staff.
What's included
- Patient enrollment & consent workflows
- Care plan documentation support
- CPT 99490 / 99491 CCM billing
- CPT 99453 / 99454 / 99457 / 99458 RPM billing
- Monthly time-tracking & compliance records
SERVICE
Operational Support for Lean Practice Teams
Cross-trained billing support that keeps claims moving when staff turn over, take PTO, or get pulled into patient-facing work.
What's included
- Dedicated billing teams & backup coverage
- Cross-training programs for front desk & billing staff
- Front-office coordination for insurance questions
- Workflow documentation so nothing depends on one person
SERVICE
Get Paid What Your Contracts Actually Owe You
Stop accepting underpayment. Expert payer contract analysis and negotiation that lifts reimbursement rates across your top payers.
What's included
- Fee schedule analysis vs Medicare benchmarks
- Underpayment detection & recovery
- Contract renewal & renegotiation support
- Payer performance scorecards
SERVICE
MIPS Reporting Done Right — No Penalties, No Guesswork
Full-service MIPS reporting and value-based care support. Maximize your quality score and avoid Medicare payment penalties.
What's included
- Quality category strategy (45% of MIPS score)
- Promoting Interoperability support (25%)
- Improvement Activities selection & attestation (15%)
- Cost category analysis (15%)
- Individual, group & virtual group reporting
SERVICE
Help Patients Find the Practice You Built
Verified Google Business Profiles, patient-review strategy, and local SEO so your services show up when patients in your area search for care.
What's included
- Google Business Profile verification & optimization
- Local SEO for service + geography searches
- Patient review generation workflows
- Website content patients actually search for
WHY OUTSOURCE
In-House Billing vs. Outsourced RCM
| Feature / Metric | In-House Billing Team | Our B2B Healthcare RCM Service | |
|---|---|---|---|
| Staff Overhead | High (Salaries, Benefits, PTO, Payroll Taxes) | Zero Overhead (Pay only on collections) | |
| Billing Turnover Risk | High (Staff sick days, resignations halt billing) | Zero Downtime (Dedicated team & backup coders) | |
| First-Pass Clean Claim Rate | 75% – 85% | 98.4%+ | |
| Average Days in A/R | 50 – 75+ Days | < 30 Days | |
| Certified Coders (AAPC/AHIMA) | Often expensive or generalist | Included across all clinical specialties | |
| Denial Management | Often ignored due to lack of time | 100% of denials appealed within 48 hours | |
| Software & Clearinghouse Costs | Practice pays all software fees | Seamless integration with your existing EHR | --- |
TECHNICAL REFERENCE
Top CARC Denial Codes & the Fix Playbook
The exact denial-resolution frameworks our teams use when working denied claims.
| Denial Code | Standard Description | Root Cause | Proven Fix & Appeal Strategy | |
|---|---|---|---|---|
| CO-4 | The procedure code is inconsistent with the modifier used. | Invalid modifier or missing required anatomical/clinical modifier. | Review NCCI edit tables. Append correct modifier (-25 for separate E/M, -59 or X{EPSU} for distinct procedural service, -RT/-LT for side). Resubmit with corrected modifier. | |
| CO-16 | Claim lacks information or has billing errors. | Missing NPI, taxonomy code, patient DOB, or referring provider. | Check the remit advice remark codes (RARC). Populate missing field in EHR/claim scrubber and resubmit as an electronic replacement (Claim Frequency Type 7). | |
| CO-18 | Exact duplicate claim/service. | Claim was submitted twice before original completed processing. | Verify original payment status. If denied in error (e.g. bilateral procedure or repeat procedure), append modifier -76 (repeat procedure) or -50 (bilateral) and submit formal appeal with operative notes. | |
| CO-22 | Coordination of Benefits (COB) issue. | Patient has primary insurance other than the billed payer. | Contact patient for updated insurance information. Bill the correct primary payer first, obtain the primary EOB, and submit secondary claim with primary EOB attached. | |
| CO-27 | Expenses incurred after coverage terminated. | Patient was not eligible on the date of service (DOS). | Verify eligibility dates via real-time clearinghouse portal. If covered under retroactive Medicaid or new commercial plan, update policy ID and rebill. If uninsured, transfer balance to patient statement. | |
| CO-29 | Timely filing limit expired. | Claim was submitted past the payer's allowed submission window. | Submit proof of initial timely submission (clearinghouse acceptance report / 999 or 277 EDI confirmation showing initial submission date within deadline). | |
| CO-50 | Non-covered service / Not medically necessary. | Diagnosis code does not support medical necessity under LCD/NCD. | Review local coverage determination (LCD). Review chart notes with treating clinician to identify secondary or more specific ICD-10 codes supporting the procedure. Submit redetermination with clinical notes. | |
| CO-97 | Benefit included in payment for another service. | Bundled service under National Correct Coding Initiative (NCCI). | Check if service qualifies as separately identifiable. If independent procedure performed at different anatomical site/session, append appropriate modifier (-59, -XU, -XS) and appeal with medical records. | |
| CO-197 | Pre-certification / Prior authorization missing. | Procedure required prior authorization that was not obtained prior to service. | If emergency/urgent, request retro-authorization. Submit appeal documentation demonstrating medical urgency and clinical notes explaining why prior auth was not feasible in advance. | |
| PR-1 | Deductible Amount. | Patient deductible has not been met. | Transfer responsibility to patient ledger. Issue automated patient statement and offer digital payment portal / text-to-pay options. | |
| PR-2 | Coinsurance Amount. | Patient coinsurance cost-share. | Bill secondary insurance if applicable; otherwise, send clear, itemized patient statement. | |
| CO-252 | Missing/Incomplete Documentation. | Additional medical records or operative report required. | Attach electronic medical records, clinical chart notes, lab reports, and doctor's signature to the claim appeal portal. | --- |
INTEGRATIONS
Works With the EHR & PM Tools You Already Use
* Enterprise & Hospital Systems: Epic Systems, Oracle Cerner, MEDITECH, Allscripts / Veradigm.
- Ambulatory & Independent Practices: AthenaHealth (AthenaOne), eClinicalWorks (eCW), Kareo / Tebra, AdvancedMD, NextGen Healthcare, Greenway Health (Intergy/Prime Suite), Modernizing Medicine (EMA).
- Specialty-Specific Platforms:
- Behavioral Health: SimplePractice, TherapyNotes, Valant, TheraNest, Qualifacts (CareLogic/Credible).
- Physical Therapy & Rehab: WebPT, Clinicient, Net Health, Prompt EMR.
- Cardiology & Surgery: Aprima, Practice Velocity, ModMed Cardiology, SIS (Surgical Information Systems).
- Chiropractic & Podiatry: ChiroTouch, TRAKnet, SammyEHR. ---
A clearer path to healthier revenue.
Start with a focused review of your billing workflow, payer mix, denial patterns, and growth plans.
Book Your Free Practice Audit