Revenue Cycle Management Solutions
Optimize your entire revenue cycle from patient registration to final payment. Our comprehensive RCM services ensure maximum revenue capture and operational efficiency.
Proven Results
Our revenue cycle management solutions deliver measurable improvements to your practice's financial performance
Our RCM Process
A comprehensive 6-step approach to optimize your revenue cycle and maximize collections
Patient Registration & Eligibility Verification
Accurate demographic and insurance information is the foundation of clean claims.
We verify insurance eligibility in real-time before every appointment — checking active coverage, deductibles, co-pays, prior authorization requirements, and HMO primary care assignments. Eligibility errors account for 23% of all claim denials. Our pre-visit verification prevents these denials before they happen. For new patients, we collect and validate all demographic data, subscriber IDs, group numbers, and secondary insurance information.
Charge Capture & Medical Coding
Precise CPT, ICD-10, and HCPCS coding is the difference between proper payment and a denial.
Our certified coders (CPC, CCS, specialty-specific certifications) review clinical documentation and assign the most accurate, highest-supported codes for every encounter. We identify missed charges — procedures performed but not billed, supply J-codes, administration codes — and bring them to your attention before the billing window closes. E/M level optimization alone typically increases primary care revenue by 15–20% without additional documentation burden.
Claims Scrubbing & Submission
Every claim is scrubbed against 3,000+ payer-specific rules before it leaves our system.
Our proprietary scrubbing engine checks for NCCI bundling conflicts, CCI edits, medical necessity alignment with LCD/NCD policies, modifier appropriateness, and payer-specific formatting requirements — all before submission. Claims that pass our scrubber go out within 24 hours of chart lock via direct EDI connections. Our 98.7% first-pass acceptance rate means your cash flow doesn't wait for corrections and resubmissions.
Payment Posting & Reconciliation
Every dollar received is posted, reconciled, and verified against your contracted rates.
When Electronic Remittance Advices (ERAs) and paper EOBs arrive, our team posts them same-day. We reconcile every payment line-by-line against your fee schedule and payer contracts — flagging underpayments as small as $5. Our variance analysis catches systematic underpayment patterns (where a payer consistently pays below contracted rate) and triggers contract dispute escalations. We also auto-generate secondary claims the moment a primary payment posts.
Denial Management & Appeals
No denial goes unworked, and no revenue is abandoned without a fight.
We classify every denial within 24 hours: technical (solvable in hours) or clinical (requires appeal). Technical denials — wrong ID, missing modifier, COB issue — are corrected and resubmitted same-day. Clinical denials trigger our three-level appeal process: first-level appeal with supporting documentation, second-level with medical records and LCD/NCD policy citation, and peer-to-peer review coordination for high-value claims. Our 96.2% appeal success rate recovers revenue most practices write off.
Patient Billing & Collections
Patient balances are collected professionally, compassionately, and efficiently.
After insurance adjudication, patient responsibility balances are billed via clear, itemized statements within 48 hours of payment posting. We offer online payment portals, flexible payment plan options, and proactive phone outreach for balances over $150. Our patient communication follows HIPAA-compliant protocols and FCC telemarketing regulations. For accounts over 120 days, we coordinate with vetted third-party collection agencies while maintaining your practice's reputation.
Benefits of Our RCM Services
Transform your practice's financial performance with our comprehensive revenue cycle management solutions
Increased Revenue
Optimize your revenue cycle to maximize collections and reduce revenue leakage
Reduced Denials
Lower denial rates through expert coding and clean claims submission
Faster Collections
Accelerate payment cycles with streamlined billing processes
Cost Savings
Reduce administrative overhead and operational costs
Compliance Assurance
Stay compliant with HIPAA, Medicare, and payer requirements
Detailed Reporting
Comprehensive analytics and performance reporting
What Outsourcing RCM Delivers
Real numbers from real practices. When you stop tolerating a broken billing operation, here’s what changes.
Average revenue improvement in first 6 months
Denials drop from avg 8.1% to under 2%
Days in AR drops from 42 to under 19 days
Eliminate billing staff overhead and software costs
We Work Inside Your Existing Systems
You shouldn’t have to change your EHR or retrain your staff to improve your revenue cycle. We access your existing billing module natively — pulling charges, posting payments, and managing AR without disruption.
AI-Powered Claims Validation
Our scrubbing engine runs 3,000+ payer-specific checks before every submission, catching errors before they become denials.
Real-Time Eligibility Verification
We verify coverage, deductibles, and co-pays for every patient before they walk in the door — eliminating eligibility denials at the source.
Automated ERA Payment Posting
Electronic remittance advices are posted same-day with line-item reconciliation against your contracted fee schedule.
EHR & PM Systems We Integrate With
Don't see yours? We integrate with 150+ systems. Contact us.
Frequently Asked Questions
Get answers to common questions about our revenue cycle management services
What is revenue cycle management?
Revenue cycle management (RCM) is the end-to-end process of managing all financial transactions in your healthcare practice — from the moment a patient schedules an appointment through final payment collection. It encompasses eligibility verification, charge capture, medical coding, claims submission, payment posting, denial management, and patient collections. Effective RCM maximizes revenue, reduces days in accounts receivable, and ensures your practice is paid correctly and promptly for every service rendered.
How quickly will I see results from RCM services?
Most practices see measurable improvements within 30–60 days. In the first 30 days, you'll see faster claim submission (within 24 hours of chart lock), reduced denial rates as our scrubbing engine catches errors before submission, and a cleared backlog if you have outstanding AR. By day 60–90, we've analyzed your payer mix, optimized your fee schedules, and begun recovering revenue from previously missed billing opportunities like CCM, AWV, or undercoded E/M visits.
What reports and analytics do you provide?
We provide a real-time client dashboard with drill-down capabilities showing: Clean Claim Rate vs. industry benchmark, Days in AR by payer, Denial Rate with root cause categories, Net Collection Rate, Revenue by provider and location, E/M distribution chart, and Payer performance comparison. Monthly executive summaries are delivered to practice leadership. All data is updated in real-time as claims are processed and payments posted.
How do you handle denied claims?
Every denial is worked within 24–48 hours — we never let claims age. We classify denials as technical (wrong ID, missing modifier, COB) or clinical (medical necessity, authorization). Technical denials are corrected and resubmitted same-day. Clinical denials go to our certified coders for appeal preparation, including documentation of supporting clinical evidence, LCD/NCD policy citations, and medical necessity justification. Our 96% appeal success rate means very little revenue is permanently lost.
Can you integrate with our existing practice management system?
Yes — we integrate with all major EHR and practice management systems including Epic, Cerner, athenahealth, eClinicalWorks, NextGen, Allscripts, Kareo (Tebra), AdvancedMD, DrChrono, and more. We access your billing module directly (read/write access) rather than requiring a separate system, so there's no duplicate data entry and no disruption to your existing clinical workflow. Integration is typically completed within 5 business days of onboarding.
What is your pricing model?
We offer two primary structures: (1) Percentage of net collections — typically 4–8% depending on specialty and volume, with no fees on uncollected claims, and (2) Flat-fee per claim for high-volume practices. There are no setup fees, no long-term contracts, and no hidden costs. We earn more when you earn more — which aligns our incentives perfectly with yours. Contact us for a customized quote based on your specialty and monthly claim volume.
What's the difference between RCM outsourcing and billing software?
Billing software is a tool — it still requires trained staff to operate it, manage denials, post payments, and follow up on AR. Outsourced RCM replaces your entire billing department: we provide the software, the certified coders, the denial management team, and the analytics reporting. The all-in cost of outsourced RCM (typically 4–8% of collections) is almost always lower than the fully-loaded cost of an internal billing team (salary + benefits + software + training + turnover costs).
How do you protect our patients' data?
We are fully HIPAA-compliant with a signed Business Associate Agreement (BAA) for every client. All data is encrypted in transit (TLS 1.3) and at rest (AES-256). We maintain SOC 2 Type II certification, conduct annual HIPAA risk assessments, and limit data access on a strict need-to-know basis. All staff undergo HIPAA training annually. Our infrastructure is hosted in HITRUST-certified data centers with 99.9% uptime SLA.
How is Healix RCM different from other billing companies?
Three key differences: (1) Specialty depth — we have certified coders for 40+ specialties, not generalists doing everything. (2) Proactive revenue finding — we don't just bill what's submitted; we identify missed CCM patients, undercoded visits, and unfiled AWVs before the billing window closes. (3) Transparency — you see every claim, every denial, and every dollar in real time. No black-box billing. Most clients discover we've found revenue they didn't know they were leaving on the table.
Ready to Optimize Your Revenue Cycle?
Get a free comprehensive analysis of your current revenue cycle and discover opportunities for improvement. Our RCM experts will provide personalized recommendations for your practice.
✓ No commitment required ✓ Results in 30 days ✓ HIPAA compliant