Solution 01 · Revenue Cycle Optimization
Front desk to final payment, run as one process.
We take ownership of the full cycle, or the parts that leak: patient access, coding and charge capture, claims, denials, A/R follow-up, and patient balances. Our operators work inside your PM and EHR, with our automation underneath them.
- Patient access & intake
- Eligibility & prior auth
- Coding & CDI
- Charge capture
- Claims & edits
- Denials & appeals
- A/R follow-up
- Patient collections
What is broken
- 01
Front-end errors become back-end denials
Most denials are decided before the visit: eligibility not verified, authorization not on file, demographics wrong. Fixing them downstream costs five times more than getting them right at check-in.
- 02
Work queues sorted by age, not by value
Teams chase the oldest claims instead of the ones most likely to pay. High-dollar, high-probability accounts age out while staff work $40 balances.
- 03
No single owner of the dollar
Front desk, coding, and billing each own a slice of the process. Nobody owns the outcome, so nobody can fix the handoffs.
What we do
Capabilities, in the order we usually deploy them.
- Patient access
- Digital intake, real-time eligibility (270/271), authorization tracking, and good-faith estimates before the patient arrives.
- Coding and CDI
- Certified coders with AI-assisted code suggestion, provider query workflows, and audit-ready documentation trails.
- Claims management
- Scrubber rules tuned per payer, edits resolved before submission, and 277 status automation so nothing sits unworked.
- Denials and appeals
- Root-cause categorization, worklists prioritized by recoverable dollars, drafted appeals, and payer escalation paths.
- A/R follow-up
- Propensity-to-pay scoring, payer-specific playbooks, and aged A/R cleanup projects with a defined end date.
- Patient financial experience
- Plain-language statements, payment plans, and text-to-pay. Patients who understand the bill pay it.
What moves
Clean claim rate
87%96%
First-pass denial rate
12%6%
Days in A/R
4834
A/R over 90 days
28%14%
Representative targets for a mid-sized physician group with a mixed payer base. Your baseline sets the actual numbers; we agree on them in the diagnostic.
In the portal
Every claim, denial, and dollar in the portal, refreshed daily, with the same worklists our operators use.
Cash collected, MTD
$21.3M
First-pass denial rate
5.9%
Days in A/R
33.8
Clean claim rate
96.1%
Cash collected
12 months · vs target
Needs attention
56 claims within 7 days of timely filing
$339.2K at stake
CO-197 denials awaiting retro-authorization
$338.4K at stake
Underpayment pattern: BCBS paying 82% of contract on 27447
$128K at stake
Speak to an expert
Let’s find the revenue you’re leaving on the table.
What happens next
- 01
A 30-minute call with an operator
Not a sales rep. Someone who has run a revenue cycle and will ask about yours.
- 02
A scoped diagnostic proposal
Fixed fee, 30 days, with the data we need listed up front.
- 03
Findings with dollars attached
You keep the report whether or not we continue together.