How we take over your billing,
stage by stage.
Four stages, and what actually happens at each one rather than a description of what revenue cycle management is. Written for the person who has to sign off on the switch and then live with it.
We read your remittance advice first
Before anything moves, we go through your aged AR by bucket and by payer, and read the last quarter of remittance advice line by line. Denials get sorted by CARC and RARC code rather than by dollar value, because the same denial reason repeating forty times is one workflow problem, not forty separate ones.
- Aged AR broken out by bucket and payer, not one total
- Denials grouped by CARC/RARC so the pattern is visible
- For infusion practices, administered units reconciled against billed units on a claim sample
- You get the findings in writing, including what we think is not worth chasing
We work inside your systems, not around them
You keep your practice management system, your clearinghouse, your payer contracts and your NPI. We work inside them. Before the first claim moves we agree a cutover date in writing, so it is unambiguous which claims are ours and which stay with whoever is billing for you now.
- EDI enrollment and ERA/EFT routing checked before cutover, not after
- A named cutover date, so no claim sits between two billers
- Credentialing and payer enrollment gaps flagged before they cause a denial
- Nothing is migrated to a system you cannot log into yourself
Claims go out daily, denials get worked on a schedule
Charges are coded, scrubbed and submitted on a daily cycle rather than batched to the end of the week. Every day a claim sits is a day of the timely filing window spent. Denials are worked to a fixed schedule rather than whenever somebody reaches them.
- NDC-to-HCPCS unit conversion checked before submission, which is where infusion billing usually leaks
- JW and JZ modifiers applied to drug wastage, correctly and consistently
- MUE limits checked against high-dose regimens before the claim goes out
- Prior authorization tracked to the treatment date, and escalated to peer-to-peer review when a payer refuses
- ERA posted automatically, the remainder posted by hand and reconciled
You see the same numbers we see
Monthly reporting shows aged AR by bucket, denial reasons ranked by both frequency and dollars, and payer-level trends over time. It also says what we could not fix and why, because a report that only contains good news is not useful for deciding anything.
- Denial reasons ranked by frequency and by dollars, not just a total
- Payer-level trends, so a single payer changing its rules is visible early
- Write-offs listed individually with the reason for each
- What we could not recover, and what we think it would take
Outsourcing the billing does not mean handing over the practice.
- Your practice management system, your login, your data
- Your payer contracts and your NPI and TIN stay in your name
- Every claim we touch is visible to you in your own system
- If you leave, your data is already yours - there is nothing to hand back
Questions about the switch
- Do you work with our practice management system?
- We work inside the system you already use rather than asking you to move. If we have not worked in yours before we will say so during the assessment instead of finding out afterwards.
- What happens to claims already in flight when we switch?
- We set a cutover date in writing. Claims submitted before it stay with your current biller; claims after it are ours. The gap between two billers is where claims are most often lost, so we would rather be pedantic about the date than tidy about it.
- When would we see a difference?
- Clean-up work on aged AR shows up before workflow changes do, because those claims already exist. Changes to coding and submission take a full payer cycle before they show in the data. We would rather set that expectation now than explain it in month two.