FAQs
Workflow and Process
We manage the entire Revenue Cycle from start to finish—ensuring accuracy, efficiency, and compliance at every step. Our approach helps healthcare providers reduce administrative burdens, avoid claim denials, and improve cash flow, all while focusing on delivering excellent patient care:
In Revenue Cycle Management, certain steps take longer or are more prone to mistakes—leading to delays, denials, and extra work. We identify Root-Cause and proactively address them with our highly experienced expertise, and best practices. And we focus on these areas to save time, reduce errors, and ensure faster payments.
The Key Challenges We Solve for New Practices:
- Patient demographics, Insurance Verification & Pre-Authorization (20–45 mins per claim)
→ We streamline insurance checks and approvals, preventing delays and claim denials before they happen. - Medical Coding (15–30 mins per claim)
→ Our certified coders ensure accurate, compliant claims, reducing rework and improving clean-claim rates. - Medical Scribing (10–25 mins per claim)
→ We support providers with templates and expert scribes, making documentation complete and error-free. - Requisition Creation & claim Submission (10–20 mins per claim)
→ Our automated workflows ensure all necessary documents are reviewed and submitted correctly the first time. - Denial Management & AR Follow-Up & Appeal process (30–60 mins per claim)
→ We track unpaid claims in real-time and intervene early, ensuring faster resolution and protecting your revenue.
We ensure that every claim—whether small or high-value—is handled efficiently, prioritized intelligently, and recovered wherever possible. We know that claims come in all sizes and that every dollar counts—but time and effort must be used wisely. Our approach ensures that claims are handled accurately, prioritized effectively, and recovered wherever possible.
Write-offs are never arbitrary—they depend on provider trace holds, reimbursement limits, and internal policies.
Claims are only written off after complete assessment and justified evaluation, ensuring maximum recovery before closure.
How We Handle Claims by Size
- Small Claims ($10–$200):
Managed quickly through automated workflows, with follow-up only when it’s financially practical. Claims are written off after evaluating provider trace holds and policy thresholds. - Moderate Claims ($100–$500):
Reviewed thoroughly when recovery is cost-effective. Follow-ups are prioritized while keeping administrative effort in check. - High-Value Claims (>$500):
Given top priority with dedicated teams, thorough audits, and persistent follow-up until payments are fully recovered.
Prioritization – Daily Aging Reports for Smarter Billing
- We run daily aging reports to track outstanding claims
- Claims are prioritized based on dollar value and how long they’ve been pending
- High-value and older claims are addressed first, ensuring that efforts are focused where they matter most
Technology and EHR/PMS Integration
We understand that every practice has its own systems and workflows. That’s why we’ve built expertise across the most widely used EHR and PMS platforms, helping practices of all sizes manage their billing—whether through automated integrations or manual processes.
Most Used Systems by Our Clients:
- Kareo – small and independent practices
- Office Ally – widely used for its cost-effectiveness and simplicity
- eClinicalWorks, NextGen Healthcare – outpatient and specialty clinics
- CPSI, Epic, Vericle, Waystar, Availity – Small physician billing and larger healthcare systems
Many of these systems also use manual billing, and we support such workflows with trained professionals to ensure accuracy and efficiency.
How We Access Data
We adapt to your system’s capabilities and workflow preferences, offering secure, compliant, and efficient access methods:
- APIs – real-time, automated exchanges for faster, error-free claims
- SFTP – secure batch transfers for large datasets
- Manual Entry / Portal Access – expert-supported for systems without integration
All methods are HIPAA-compliant, secure, and tailored to your practice’s needs.
Why Practices Trust Us
✅ We adapt to your existing system—no need for expensive upgrades
✅ We ensure data is handled securely and accurately, whether automated or manual
✅ We streamline billing processes, saving time and reducing administrative effort
✅ Our flexible solutions work across systems like Office Ally, kareo, Vericle and more
✅ You get expert support, smarter workflows, and faster reimbursements without disruption
We integrate with a variety of systems, but not all offer full API access. We’re prepared to handle these challenges without disrupting your practice
Common Challenges
- Limited or no API access, especially in smaller or older systems
- Inconsistent data formats, requiring adjustments
- Incomplete documentation, needing verification
- Compliance concerns with data security and privacy
- Custom workflows that need specialized handling
Use of non-API Methods:
- In 30–40% of integrations, especially with small or specialty practices, we rely on CSV exports, SFTP transfers, or manual entry due to limited API access
- Our team is trained to handle diverse file formats and reconcile data to ensure billing accuracy
- Manual processes are treated with the same rigor as automated ones to maintain compliance and efficiency
Why This Matters for Your Practice
- You get expert support even if your system doesn’t offer modern API integrations
- Our processes ensure data accuracy, security, and compliance across all transfer methods
- Whether automated or manual, we ensure billing is smooth, timely, and error-free
We integrate AI and automation tools to enhance efficiency—but we combine these with human expertise to ensure accuracy and compliance. We use AI for speed and prediction, but rely on certified coders, RCM experts, and human oversight for final reviews, appeals, and complex denials.
Claims Prioritization:
- Automated workflows sort claims based on dollar value, aging, and denial likelihood
- Ensures teams focus on claims with the highest impact
Appeal Drafting Assistance:
- AI generates standardized appeal drafts using claim and payer data
- Reduces manual work but requires human review for payer-specific nuances
Denial Management and Appeals
We understand that claim denials are a major challenge for practices, impacting cash flow, staff productivity, and overall revenue. Our approach to minimize denials, recover the maximum revenue, and allow providers to focus on patient care rather than billing challenges.
Major 5 Reasons for Claim Denials
- Prior Authorization & Eligibility Issues: Claims submitted without required approvals or missing verification details.
- Coding Errors: Inaccurate, incomplete, or outdated CPT/ICD codes.
- Incomplete Documentation: Missing clinical notes, signatures, or required patient information.
- Incorrect Patient or Insurance Information: Demographic errors, invalid policy numbers, or mismatched coverage.
- Payer-Specific Rules & Requirements: Special rules, limitations, or coverage exclusions that vary by insurer.
Our Appeal Strategy
- Appeal Rate: We appeal 80–90% of denials, focusing on recoverable claims and high-value denials.
- Prioritization: Daily aging reports help us target claims by dollar value and age, ensuring timely follow-ups.
- Outcome-Focused: We aim to maximize recoveries while ensuring compliance with payer and regulatory rules.
We know that not every denied claim is worth pursuing. Our goal is to recover as much revenue as possible while using resources efficiently. That’s why we prioritize appeals based on data, dollar value, and the likelihood of success.
We Prioritize Denials
- Dollar Value:
- High-value claims are reviewed first, as recovering them has the greatest financial impact.
- Aging Reports:
- We run daily aging reports to track how long claims have been outstanding
- Older claims are prioritized to avoid missing deadlines for appeals
- Correctable Errors:
- Claims with documentation, coding, or authorization errors that can be easily fixed are appealed quickly
- Payer-Specific Rules:
- We focus on denials where appeals have a higher likelihood of being accepted based on payer guidelines.
- Simple appeals (documentation errors, missing info): 15–30 minutes
- Complex appeals (payer-specific rules, authorization issues): 30–45 minutes
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- AI-Powered Templates:
- Suggest standardized appeal drafts based on payer and claim type
- Reduces manual writing and ensures completeness
- Automated Workflows:
- Prioritize appeals by aging, dollar value, and recoverability
- Set reminders and track deadlines to avoid missing appeal windows
- Real-Time Reporting:
- Provides visibility into appeal status, success rates, and bottlenecks for continuous improvement.
- AI-Powered Templates:
Client and Specialty Focus
Certain specialties face more claim denials due to complex rules, documentation needs, or prior authorization requirements.
Specialties with the Highest Denials:
- Behavioral Health: Authorization problems, session limits, and documentation gaps.
- Radiology/Imaging: Coding mistakes, coverage restrictions, and missing approvals
- Physical & Occupational Therapy: Medical necessity questions and incomplete paperwork
Typical Claim Volumes:
- Small practices: 500–2,000 claims per month
- Medium practices: 2,000–10,000 claims per month
- Large groups or networks: 10,000+ claims per month (So far, we did not handle large groups).
We know that billing can be one of the biggest headaches for medical practices. Here’s what our clients face—and how we help.
Common Billing Challenges
- Insurance Rules & Prior Authorizations:
→ Complex requirements cause delays and denials - Coding Mistakes & Missing Documentation:
→ Errors lead to rejected or unpaid claims - Lack of Trained Staff:
→ Overwhelms existing teams and slows down billing - Manual, Time-Consuming Processes:
→ Increases workload and delays payments - Unpredictable Cash Flow:
→ Financial stress from unpaid or late claims
How We Help:
- ✔ Expert Teams: Certified billing specialists and coders handle claims accurately
- ✔Real-time SWAT analysis → quick error resolution with full transparency.
- ✔ One-Vendor Solution: One-Vendor Solution: RCM + Recruitment under one roof
- ✔ Daily Monitoring: We track old claims to recover payments faster
- ✔ Flexible Pricing: Affordable solutions that fit practices of all sizes
Staffing and Scalability
We understand that every practice has different needs—whether you’re a small clinic or a large healthcare network. Our team is built to scale with you and provide specialized support at every step of the billing process, ensuring you get accurate, compliant, and timely payments.
Monthly Claim Capacity
- Small practices: Up to 2,000 claims per month
- Medium practices: 2,000–10,000 claims per month
- Large practices or networks: 10,000+ claims per month
We adjust capacity based on your claim volume, ensuring you get the support you need.
Our Staffing Structure
- Certified Coders: Ensure accurate coding and compliance
- Accounts Receivable (AR) Specialists: Manage payments, follow-ups, and appeals
- Denial Management Experts: Identify and resolve denied claims quickly
- Data Analysts: Run reports, monitor trends, and improve workflows
- Support Staff: Handle patient inquiries, insurance verification, and documentation checks
Each practice gets a dedicated account manager to oversee the team and ensure smooth communication and fast issue resolution.
Why Our Staffing Model Works:
- In-house recruitment for all RCM roles
- One-Vendor Solution: RCM + Recruitment under one roof.
Scaling smoothly when onboarding new clients is key to ensuring consistent, high-quality billing services. We follow a structured approach that allows us to grow without compromising accuracy, speed, or compliance.
Our Scale When Adding New Clients
- Understand Your Needs First:
→ We review your practice size, specialty, and systems to create a customized plan - Add the Right Team Quickly:
→ We expand our team with trained coders, AR specialists, and support staff as needed
→ Our network of professionals helps us onboard smoothly without delays - Follow Proven Workflows:
→ We use structured processes and regular audits to ensure accuracy and compliance - Assign Dedicated Support:
→ Every client gets a manager who oversees their account and solves issues quickly
Challenges We See with Growing Claim Volumes
- Keeping Claims Accurate:
→ More claims can lead to more mistakes if not managed properly
→ We double-check and review every claim to prevent errors - Integrating Different Systems:
→ Practices use various EHR or billing systems, which may need adjustments
→ Our team is experienced in working with all major platforms - Hiring and Training:
→ Scaling quickly means finding qualified staff fast
→ We maintain a ready pool of trained professionals to support you - Ensuring Compliance:
→ Larger volumes increase audit risks
→ We use strict checks and documentation protocols to stay compliant
As your practice grows, we ensure billing stays smooth, accurate, and stress-free.
Metrics and Performance
We focus on submitting clean, accurate claims from the start and recovering as much lost revenue as possible.
- First-Pass Acceptance Rate:
✔Our average first-pass acceptance rate is 95–96%, meaning most claims are processed without issues on the first submission
✔ This high rate is achieved through expert coding, proper documentation, and thorough insurance verification - Revenue Recovery from Denials & Underpayments:
✔ We recover 65–75% of denied or underpaid claims, depending on the case complexity and payer rules
✔ By prioritizing high-value and correctable claims, we ensure maximum revenue is recouped
✔ Daily aging reports and appeals workflows help us resolve claims quickly, reducing revenue loss
We believe transparency and accountability are key. We provide clear, actionable reports so clients always know how their billing is performing and where improvements can be made.
How We Measure Performance
✔ We track key metrics daily, weekly, and monthly
✔ Our reports include both real-time dashboards and detailed summaries
✔ We highlight issues early and provide recommendations for faster resolution
Other
✅ That’s great! Many of our clients did too — but they switched because we cover more than just billing: eligibility, authorizations, denials, AR, staffing — everything under one roof.
✅ Perfect! We don’t replace your team — we support them. You can offload high-volume tasks like eligibility verification, AR follow-up, or denials, and get certified staff whenever you’re short-handed.
✅ True — which is why we ensure smooth onboarding with a dedicated account manager. Most clients see measurable improvements within 30–45 days.
✅ Our services often pay for themselves. Clients typically save 30–40% compared to in-house teams and see 15–25% growth in collections.
👉 Usually within 30–60 days, with major improvements in AR and denials within 90 days.
👉 No. We work with all major EMR and PMS systems — no migration needed.
👉 Yes, we prefer Office-ally PMS systems, where we can check eligibility, claim billing, claim status, Payment remittance & appeals etc.
👉 We serve a wide range of specialties, including:
• Primary Care
• Internal Medicine
• Labs & Diagnostics
• Radiology
• Behavioral & Mental Health
• Telehealth
• Cardiology
• Orthopedics
• Physical & Occupational Therapy
• Chiropractic
• Dental
• Ophthalmology
• DME (Durable Medical Equipment)
• Elder Care, Hospice, SNFs, and more.
👉 We focus first on high-dollar and high-aging claims to prevent revenue leakage, while keeping new claims moving to maintain cash flow.
👉 We focus first on high-dollar and high-aging claims to prevent revenue leakage, while keeping new claims moving to maintain cash flow.
- Claim submission: 24–48 hours
• Payment posting: within 24 hours of ERA/EOB receipt
• Denial resolution: within 7–14 days (depending on payer)
• 100% HIPAA-compliant operations
• Encrypted servers, VPN-only access, and audit trails
• NDA-signed staff with restricted PHI access
• AI tools used only within secure, compliant frameworks
👉 Our AI tools only automate workflow and prioritization — PHI never leaves secure systems. All tools are fully HIPAA-compliant.
👉 Yes, we sign BAAs with all clients to ensure full compliance and data security.
• One billing staff: 2,500–3,500 claims/month
• A 10-member team: 25,000–35,000 claims/month
We scale seamlessly with your volume.
👉 Yes. We specialize in denial cleanup and old AR recovery, bringing uncollected revenue back into your system.
We maintain a ready-to-deploy certified talent pool and SOP-driven workflows to scale instantly — whether doubling claim volumes or adding new specialties.
• Identify root cause (coding, eligibility, pre-auth)
• Categorize by payer and dollar value
• Use payer-specific appeals and escalation strategies
• Recover 15–25% of denied or underpaid claims that would otherwise be lost
👉 95–98% clean claims, significantly higher than industry averages.
• Weekly dashboards – AR trends, denials, collections
• Monthly executive summaries – financial KPIs & improvements
• Ad-hoc reports – for audits, reviews, or management meetings
👉 Transparent dashboards, reports, and real-time updates — so you always know your financial health.
👉 Clients typically see a 15–25% increase in overall collections and a 50% reduction in AR > 90 days within the first few months.
👉 Yes. We manage provider enrollment, credentialing, and prior authorization end-to-end.
👉 Yes. We can train your in-house billing team or provide certified remote resources as an extension of your practice.
👉 Absolutely! We support solo practitioners, labs, and large multi-specialty groups with equal focus.
👉 We can scale instantly by adding trained, certified staff — no downtime or disruption.
👉 Yes — we offer white-label services, so we can represent your brand directly.
👉 Flexible pricing options:
• % of Collections (performance-based)
• Flat Fee per FTE (staff augmentation)
• Per-Claim Basis or Hybrid Model
Clients generally save 30–40% vs in-house.
• AI-driven + human expertise
• Dedicated account managers
• High-dollar claim focus
• 30–40% cost savings
• 24/7 availability & full transparency
• Proactive denial prevention from eligibility to coding
• First Pass Acceptance Rate: 95–98%
• AR > 90 Days: Reduced by 50% in 3 months
• Denial Resolution Success: 90–95%
• Collection Efficiency: Up 20–30% in 6 months
• Claim TAT: 24–48 hours
✅ Reduce denials & speed up cash flow
✅ Focus on patient care while we handle RCM
✅ Transparent dashboards & measurable KPIs
✅ Scale without overhead
✅ Dedicated specialists for every RCM stage
✅ Recover lost revenue & boost profitability