Growing A/R, repeat denials and payments that never match charges? Our healthcare revenue cycle management services fix the whole cycle, from the eligibility check to the final payment.
Works inside your existing EMR and clearinghouse
Most practices do not notice revenue leaking until the numbers are already behind. These are the problems we see most, and how our RCM services fix each one.
The problem: more claims sit past 60 and 90 days, and nobody has time to work them. Our fix: aging claims are worked every day, before filing and appeal limits pass.
The problem: eligibility, coding or authorization denials return for the same reasons every month. Our fix: we trace each denial to its root cause and fix it at the front desk or in coding.
The problem: ERAs are posted without being checked against expected amounts. Our fix: every payment is compared with your fee schedule, so underpayments are flagged and appealed.
The problem: patients switch plans and nobody catches it before the visit. Our fix: coverage, benefits and prior authorization are checked before every appointment.
The problem: credentialing delays hold back revenue from new hires for months. Our fix: we prepare and track every payer application so new providers can bill sooner.
The problem: you cannot see what was billed, paid and still open without asking. Our fix: weekly or monthly reports show it, with one point of contact to explain the numbers.
Revenue cycle management services cover every step from a patient booking a visit to your practice being paid in full. That includes eligibility checks, charge review, claim submission, payment posting, denial work and reporting.
RCM is more than billing. Billing sends claims. RCM connects every step, so a problem found at one stage gets fixed at its source. It stops repeating on the next hundred claims.
With Prime Medical Revenue, one team runs that whole cycle for you. You get one point of contact, regular reports and a process that keeps getting cleaner. Many healthcare revenue cycle solutions ask you to switch software. Ours work inside the EHR you already use.
A healthy revenue cycle has three parts. Each one sets up the next.
Insurance eligibility, benefits and prior authorization needs are confirmed before the patient arrives. Most denials can be stopped here.
Charges are reviewed for accurate CPT, ICD-10-CM and HCPCS codes and modifiers before anything is billed. Our medical coding services handle this step.
Claims are scrubbed against payer edits and sent through our claim submission services. Payments are posted and reconciled to each charge by our payment posting team.
Denied claims are worked first, appealed within filing limits and traced to the root cause.
Unpaid and aging claims are worked before filing and appeal limits pass.
Weekly or monthly reports show what was filed, paid and still outstanding.
Billing is one part of the revenue cycle. This is how the two compare.
Medical billing
Creating, sending and following up on claims
Often left to your front desk
Worked one claim at a time
Claims filed and paid
Revenue cycle management
Every step from eligibility to final payment
Coverage and authorization verified before each visit
Traced to the root cause and fixed at the source
Clean claim rate, denial rate and days in A/R
Four steps to take over your revenue cycle without disrupting cash flow.
We look at your payer mix, open A/R and how billing runs today. Then we agree on what we take over first.
We work inside your existing EMR, practice management software and clearinghouse.
Verification, claims, posting and follow-up run as one daily routine. Your staff get one clear point of contact.
Regular reports show results, and recurring issues are fed back so the front end keeps getting cleaner.
These numbers show whether a revenue cycle is healthy. We track them so you can see progress over time.
Clean claim rate
Share of claims accepted on the first submission
Clean claims get paid faster and cost less to process
Denial rate
Share of claims denied by payers
A high rate points to problems at the front end or in coding
Days in A/R
Average time from service to payment
Fewer days means cash reaches your practice sooner
A/R over 90 days
Share of receivables older than 90 days
Older claims are harder to collect
Net collection rate
Share of collectible money actually collected
Shows how much allowed revenue is being left behind
Payers deny more claims than most practices expect. In a Premier Inc. survey, nearly 15% of claims to private payers were denied at first. Fighting each one cost an average of $43.84. More than half of those denials were later overturned and paid.
That is money a practice should have received the first time. A connected revenue cycle stops many denials before they happen and works the rest while they can still be recovered.
Deadlines matter too. In Texas, practices have 95 days to file a claim. Under state prompt pay rules, payers must pay clean claims within 30 days (electronic) or 45 days (paper). We track both sides on every claim.
Sources: Premier Inc. and Texas Department of Insurance.
Revenue cycle management companies can look alike on paper. These questions show how each RCM partner actually works.
Our revenue cycle management solutions are built for independent practices and physician groups. You get one accountable team instead of several vendors.
Every specialty has its own revenue cycle risks. We adjust the front-end checks and coding review to match your specialty’s rules.
We bill for a wide range of specialties. See the full list on our specialties page.
We run revenue cycle management for practices in all 50 states. We follow each state’s Medicaid rules and its Medicare contractor. Texas practices also get daily experience with Novitas, TMHP and the STAR plans.
See how we support practices in Austin, Houston and Dallas, or read about our work across Texas.
Getting started
Five simple steps from the first call to clean monthly reports.
1
Tell us about your practice, payers and how your revenue cycle runs today. We reply within one business day.
2
We look at your open A/R, denial patterns and payer mix, and show where revenue is slipping.
3
We work inside your EMR, practice management software and clearinghouse. No software switch.
4
Our team takes over your revenue cycle on an agreed start date. Your staff get one point of contact from day one.
5
Weekly or monthly reports show what was filed, paid and still open, and what we fixed.
Revenue cycle management services handle every step between a patient booking a visit and your practice being paid in full. That covers eligibility, coding, claims, payment posting, denials and A/R follow-up. A good RCM partner connects these steps, so problems are fixed at their source.
RCM services include eligibility checks, charge review, claim submission, payment posting, denial management, A/R follow-up and reporting. One team runs them as one workflow. Problems found at one step are fixed at the source, so they stop repeating on later claims.
Medical billing is the part that creates and sends claims. Revenue cycle management covers the full path from scheduling to final payment. That includes the front-end checks that prevent denials and the follow-up that collects what is owed.
No. You can outsource single services, such as credentialing or denial management, and keep the rest in-house. Many practices start with one part of the cycle. They add more once they see the results in their reports.
Our teams work in many billing systems, including eClinicalWorks, AdvancedMD, athenahealth, Epic and NextGen. We also work with any clearinghouse. You keep your current software, so your staff do not have to learn new tools.
We provide revenue cycle management services to practices in all 50 states. Our office is in Austin, and clients can visit by appointment. Most practices work with us by phone, email and Microsoft Teams.
RCM companies usually charge a percentage of collections or a flat fee per claim. Our price depends on your specialty, claim volume, payer mix and the services you need. We quote after a free consultation and billing review, so you know the cost before you decide.
No. Our healthcare revenue cycle management services are built for physician practices, clinics and medical groups. We do not run hospital revenue cycles. That focus lets one team learn your providers, your payers and your workflow in detail.
Contract terms are discussed and agreed with each practice before onboarding. They depend on your service agreement and the services you choose. We go through the terms with you during the free consultation, so you know them before you sign.
Tell us about your practice. A billing specialist will get back to you within one business day.
5900 Balcones Drive STE 100, Austin, TX 78731
Open 24 hours, 7 days a week
Tell us where your revenue cycle stalls. The consultation is free, and we reply within one business day.
