The RCM Cycle
Ten steps.
One seamless cycle.
Each step can break. We know where, and why. Choose a step to see what goes wrong there and how we handle it.
Before the visit
01 • Demographics Entry
A misspelled name, a transposed member ID, or a stale address is enough to reject a claim before clinical review. We capture and validate patient and subscriber data at registration, resolving inaccuracies at the source.
Before the visit
Demographics Entry
- 01Before the visit
Demographics Entry
Patient and subscriber details captured correctly the first time.
A misspelled name, a transposed member ID, or a stale address is enough to reject a claim before clinical review. We capture and validate patient and subscriber data at registration, resolving inaccuracies at the source.
- 02Before the visit
Eligibility Verification
Coverage confirmed before the visit, not discovered after a denial.
Every scheduled patient is verified ahead of their appointment for active coverage, plan type, network status, effective dates, and coordination of secondary benefits. Your front desk receives clear confirmation before the patient arrives.
- 03Before the visit
Benefits Verification
Exact coverage details and patient financial responsibility.
Eligibility confirms active coverage, while benefits verification details exact payment terms. We confirm deductibles met, copays, coinsurance, visit limits, and remaining out-of-pocket balances to establish patient responsibility before care.
- 04Around the encounter
Charge Entry
Every procedure performed is posted accurately daily.
Charges are posted daily against your master schedule. We systematically reconcile all completed appointments against posted charges, capturing unbilled procedures while clinical documentation is fresh.
- 05Around the encounter
Charge Validation
ICD and CPT codes thoroughly validated against documentation.
We audit and validate procedure and diagnosis codes against provider documentation, ensuring medical necessity, accurate E/M levels, correct modifier usage, and full coding compliance.
- 06Around the encounter
Claim Creation
Clean claims tailored to specific payer rules.
Claims are constructed according to exact payer rules, ensuring correct place of service, referring provider IDs, prior authorization numbers, and required secondary attachments prior to transmission.
- 07Around the encounter
Claim Submission
Scrubbed, submitted, and rejections resolved same-day.
Claims undergo rigorous pre-submission scrubbing. Any clearinghouse rejections are corrected and resubmitted the same day, protecting your timely filing windows.
- 08After the claim goes out
Payment Posting
Posted within 24 hours and verified against contracted fee schedules.
ERAs and EOBs are posted at line level within 24 hours. Payments are audited directly against your contracted fee schedules, turning underpayments into an active recovery worklist.
- 09After the claim goes out
AR Follow-up
Worked systematically by balance, age, and timely filing risk.
Aged receivables are prioritized by dollar value, age, and filing deadlines. Payer follow-up occurs on a strict cadence with structured escalation for claims held in review.
- 10After the claim goes out
Denial Management
Root-cause analysis, appealed claims, and proactive prevention.
Every denial is categorized to its root cause, appealed with complete clinical documentation, and analyzed to prevent repeat denial triggers.
Get a Free Revenue Cycle Assessment
Send us a sample of your denials and aged AR. We'll come back with where the money is going, what it's worth to fix, and how long it takes.