Revenue Cycle Management
Turn every encounter into revenue.
Revenue is the foundation of a successful healthcare practice. Verified RCM's end-to-end Revenue Cycle Management streamlines billing operations, improves claim accuracy and accelerates reimbursements. By proactively managing every step of the revenue cycle, we reduce administrative burdens, strengthen financial performance and let providers focus on delivering exceptional patient care.
Talk to a specialistWhat's included
Virtual assistance
- ✓Patient scheduling, reminders and no-show management
- ✓Front-desk call handling and patient communication
- ✓Insurance eligibility and benefits verification
- ✓Medical records and EHR/EMR management
Prior authorization & eligibility
- ✓Real-time insurance eligibility checks
- ✓Authorization submission and persistent payer follow-up
- ✓Authorization number and expiration tracking
- ✓Peer-to-peer review coordination for denied authorizations
Medical coding (CPT, ICD-10, HCPCS)
- ✓Certified coders across E/M, surgical and diagnostic coding
- ✓Modifier application, bundling and unbundling review
- ✓HCC risk-adjustment coding for Medicare Advantage
- ✓Pre-bill coding audit and compliance checks
Medical billing & claim submission
- ✓Charge capture, claim scrubbing and EDI 837 submission
- ✓Clearinghouse rejection monitoring and resolution
- ✓ERA/EOB payment posting and reconciliation
- ✓Systematic accounts receivable follow-up
Denial management & appeals
- ✓Denial categorization and root cause analysis
- ✓Clinical and administrative appeal preparation
- ✓Peer-to-peer review scheduling
- ✓Monthly denial trend reporting and prevention planning
Patient balance & collections
- ✓Itemized statements delivered by mail, email and portal
- ✓Multi-touch, HIPAA-compliant collection workflow
- ✓Online payment portal, text-to-pay and QR payments
- ✓Payment plans and financial-assistance screening
The revenue cycle, step by step
Every dollar a practice collects travels through the same sequence of steps, and a weakness at any one of them shows up as denied, delayed or lost revenue. We work all of them, not just submission.
- Eligibility and benefits verificationChecked before the visit, not discovered after a denial. Confirms active coverage, plan-specific benefits and whether the service requires prior authorization.
- Prior authorization, where requiredSubmitted and tracked to approval, with the authorization number and expiration date recorded against the scheduled service.
- Medical codingCertified coders assign CPT, ICD-10 and HCPCS codes with the modifiers, bundling checks and specialty-specific review that keep a claim from being flagged before it even reaches the payer.
- Charge entry and claim submissionClaims are scrubbed against payer-specific edit rules and submitted same-day rather than batched at the end of the week, which is where avoidable delay accumulates.
- Payment posting and reconciliationERA and EOB payments are posted and reconciled against what was billed, so underpayments are caught rather than absorbed silently.
- Denial management and appealsEvery denial is categorized by root cause and worked within 48 hours, both to recover that claim and to fix the front-end issue causing it to repeat.
- Patient balance and collectionsClear statements, an online payment option and a respectful, HIPAA-compliant collection workflow close the loop to a zero balance.
Benchmarks worth tracking
| Metric | Healthy range | What it tells you |
|---|---|---|
| Clean claim rate | 95–99% on first submission | How much rework your front end is creating downstream |
| Days in A/R | Under 40 days average | How long cash is tied up between service and payment |
| Denial rate | Under 5–10% of claims | Whether eligibility, coding and authorization are working upstream |
| Net collection rate | 95%+ of allowed amount | What you actually keep after contractual adjustments |
| Denial turnaround | Worked within 48 hours | Whether appeals are filed before timely-filing deadlines close |
Frequently asked questions
What counts as a good clean claim rate?
High nineties on first submission is a reasonable target for most specialties, though the achievable number depends on payer mix and how procedural the specialty is. What matters more than the headline number is the trend: a clean claim rate that is flat or falling points at a front-end problem, usually eligibility or coding, that is cheaper to fix before submission than after a denial.
How do you actually get paid faster, not just more accurately?
Speed and accuracy come from the same fixes. Eligibility checked before the visit avoids the wait for a denial to discover coverage lapsed. Same-day charge entry and daily claim batches remove the lag between the encounter and the payer receiving it. Denials worked within 48 hours instead of sitting in a queue prevent the appeal window from closing. None of this is one big change, it is removing the small delays that compound across every claim.
Do you take over billing mid-cycle, or only from a clean start?
Most engagements start mid-cycle. We inventory the existing accounts receivable, separate what is realistically collectible from what should be written off, and take over new claims immediately while working the backlog in parallel. A full changeover after go-live, not a delayed one.
What is the difference between RCM and just billing?
Billing is submitting the claim. Revenue cycle management is everything from eligibility verification before the visit through coding, submission, denial resolution and patient collections until the balance is zero. A biller who only submits claims has no accountability for what happens after a payer rejects one, which is where most lost revenue actually occurs.
How is pricing structured?
A percentage of collections, so our incentive is aligned with yours from day one. No flat monthly fee regardless of performance, and no long-term contract lock-in.