Medical billing and revenue cycle management services for U.S. hospitals and clinics
End-to-end medical billing services for hospitals, critical access hospitals, rural health clinics, FQHCs, and physician groups. Clean claim submission, denial management, A/R recovery, payment posting, medical coding.
End-to-end execution for U.S. hospitals and clinics, staffed by senior revenue cycle specialists and supported by proven tools for accuracy and speed.
High-volume claims, denials, and A/R worked with defined cadence and governance.
Clean submissions, fast denial touches, and A/R follow-up without extra overhead.
Full revenue cycle management covering every step from eligibility verification through accounts receivable recovery, configured separately for each facility type with dedicated coding teams, payer playbooks, and compliance workflows matched to how you bill.
Critical access hospital (CAH) billing
End-to-end revenue cycle management for CAHs, including eligibility, prior authorization, medical coding, claims submission, denial management, payment posting, and A/R recovery. Specialized expertise in Method II billing, swing-bed coding, and Medicare cost report reconciliation.
Rural health clinic (RHC) billing
End-to-end revenue cycle management for RHCs, including eligibility, prior authorization, medical coding, claims submission, denial management, payment posting, and A/R recovery. Specialized expertise in all-inclusive rate billing, productivity standards, and Medicare Advantage wrap-around payments.
Community hospital billing
End-to-end revenue cycle management for community hospitals, including eligibility, prior authorization, medical coding, claims submission, denial management, payment posting, and A/R recovery. Specialized expertise in DRG validation, status audits, 340B billing, and contract variance recovery.
Physician groups billing
End-to-end revenue cycle management for physician groups and IPAs, including credentialing, eligibility, medical coding, claims submission, denial management, payment posting, and A/R recovery. Specialized expertise in HCC risk-adjusted coding, value-based care reporting, and capitation reconciliation.
Urgent care center (UCC) billing
End-to-end revenue cycle management for urgent care centers, including eligibility, medical coding, same-day claims submission, denial management, payment posting, and A/R recovery. Specialized expertise in self-pay conversion, occupational medicine contracts, and high-volume walk-in workflows.
Hospice and palliative care billing
End-to-end revenue cycle management for hospice and palliative care providers, including eligibility, medical coding, claims submission, denial management, payment posting, and A/R recovery. Specialized expertise in HIS submissions, Notice of Election, hospice cap monitoring, and GIP billing.
Dedicated workflows for high-impact specialties, with clean submissions, denial resolution, and aging control.
Time-based CPT coding for 90791, 90834, and 90837, telehealth place-of-service accuracy, and state parity law enforcements.
No Surprises Act compliance, IDR workflow management, and strict defense against payer downcoding from 99285 to 99284 for acute care facilities.
ASC place-of-service 24 coding, payment indicator grouping, device-intensive adjustments, and contract variance audits for multi-specialty surgical centers.
Durable medical equipment billing with CMN validation, modifier KX, GA, and GY application, capped rental tracking, and Medicare DMEPOS jurisdiction compliance.
Full OASIS to final claim workflow under PDGM with HIPPS accuracy, LUPA monitoring, NOA timely filing, and denial defense for face-to-face documentation.
Modifier 25 and 59 accuracy, global period tracking, implant carve-out reconciliation, and multiple-procedure discount appeals across ASC, outpatient, office settings, etc.
J-code management, NDC-to-HCPCS crosswalks, infusion hierarchy coding, and wastage modifier JW and JZ application for chemotherapy, immunotherapy, etc.
Professional 26 and technical TC component splits, MPPR reduction audits, and front-end prior authorization across diagnostic, and teleradiology workflows.
Interventional cardiology coding, modifier 26 and TC splits, device monitoring billing, and prior authorization management with LCD and NCD compliance built in.
We provide enterprise-grade revenue cycle infrastructure for the entire healthcare spectrum. Whether you are an independent specialty clinic or a high-volume regional hospital system, our recovery protocols scale to your exact claim volume, ensuring every dollar is accurately accounted for and collected on time.
Our senior revenue engineers bring over two decades of experience from the highest levels of the U.S. healthcare system. We’ve seen every payer shift since the 90s.
A collective track record of managing massive claim volumes with surgical precision. We understand the high-velocity requirements of enterprise health systems.
Our technical precision consistently outperforms industry benchmarks. We don't just "bill"; we engineer claims for maximum realized reimbursement.
Denial management, A/R follow-up, and eligibility controls. Start with the area driving the most leakage.
Denial management, accounts receivable follow-up, and payment posting operated with senior oversight and documented outcomes.
Clinical oversight by senior, credentialed experts
Most RCM firms rely on entry-level staffing to reduce costs. RCMGen utilizes experienced workforce to engineer audit-proof claims. Our senior RCM experts navigate complex CCI edits and Local Coverage Determinations (LCD) to ensure a 99.2% clean claim rate and maximize your Net Collection Ratio (NCR).
Seamless operation across Epic, Oracle Health, eCW, and all major EHRs
Our teams are system-agnostic and fully trained to operate securely within your native environment, including Epic, Oracle Health (Cerner), Athenahealth, eClinicalWorks, NextGen, Meditech, AdvancedMD, Allscripts, and dozens more. We process your claims, post your payments, and manage your EDI files in the background, ensuring zero disruption to your doctors and daily workflow.
Strategic denial resolution with real-time payer intelligence
We defend your revenue using real-time surveillance of shifting payer medical policies. From navigating BCBS modifier rules to ensuring No Surprises Act compliance, our internal Intelligence Hub provides our clinical appeals team with the forensic data required to overturn complex CO-16, PR-1, and MR rejections. We aggressively pursue the reimbursement your facility is contractually owed, recovering "silent" underpayments.
HIPAA and SOC 2 Type II Security Protocols
Protecting your Protected Health Information (PHI) is our highest fiduciary duty. RCMGen operates as a Delaware-registered corporation. Our global delivery centers utilize encrypted, HIPAA-aligned, and SOC 2 Type II compliant infrastructure. You gain the high-speed production of a 24/7 workforce, backed by rigorous Business Associate Agreements (BAAs) and institutional-grade cybersecurity.
Notes from provider teams after denials, follow-up cadence, and posting exceptions are stabilized.
As UnitedHealthcare transitioned to their 2026 automated medical necessity triggers, our internal team saw a 22% spike in 'unrecoverable' denials. Rcmgen's Revenue Engineers didn't just appeal; they re-engineered our clinical documentation to meet the new March 2026 Texas statutory requirements, recovering $4.2M in 'dead' capital within 90 days.
The 24-hour sun-cycle is a fundamental shift in cash velocity. Under the 2026 Indiana IC 27-8-5.7 Clean Claim standards, timing is everything. RCMGen’s ability to reconcile our daily ledger by 8:00 AM EST has reduced our Days in AR from 48 to a record 21.2 days.
Rcmgen performed a 90-day look-back audit on our 2025 claims that revealed a 12% revenue leakage in Wellmark BCBS contractual variances. Their specialized knowledge of Iowa’s HF 711 transparency laws allowed us to recover millions in previously finalized underpayments.
Proven Revenue Solutions for Every Care Setting
Whether you manage a growing specialty clinic or a multi-location health system, our billing infrastructure adapts directly to your specific claim volume and payer mix.
24-Hour Revenue Operations
In the modern US healthcare landscape, delay is the primary driver of denials. Our operational command centers in India and the US operate on a continuous 24-hour sun-cycle. While your facility focuses on patient care, our Elite Recovery Squad is resolving complex denials and scrubbing high-volume claims in real-time. You wake up to a reconciled ledger and optimized cash flow.
RCMGen represents the new standard in jurisdictional revenue governance. Their sun-cycle protocol ensures that high-volume claims and complex appeals are finalized with fiduciary integrity before the business day begins.
Indiana's IC 27-8-5.7 Clean Claim statute, Wisconsin's ForwardHealth / DHS 107 updates and Illinois's HealthChoice MCO taxonomies shape a denial pattern unique to this region. Our Midwest desk integrates state fee-schedule refreshes within 72 hours.
Focus States: Indiana · Wisconsin · Illinois · Michigan
Arkansas BCBS commercial dominance, ARHOME Medicaid dual-standard adjudication, TennCare MCOs and Kentucky's 907 KAR Medicaid rules. Built for CAHs, RHCs and FQHCs that run on thin margins and punishing payer mix.
Focus States: Arkansas · Tennessee · Kentucky · Alabama · Mississippi
Heritage Health (NE), KanCare (KS), South Dakota's post-Amendment D Medicaid expansion, North Dakota CAH economics. Method II billing, swing-bed coding, REH transition billing and 340B contract pharmacy covered end to end.
Focus States: Nebraska · Kansas · South Dakota · North Dakota · Iowa
Florida's Medicaid Managed Medical Assistance program, Georgia's Pathways to Coverage and South Carolina's Healthy Connections each carry distinct prior-auth rules. High patient-pay volume demands a PFS strategy most vendors skip.
Focus States: Florida · Georgia · South Carolina · North Carolina
Colorado Health First, Utah Medicaid ACOs, Idaho IMPlus, and Wyoming's CAH-heavy footprint. Rural telehealth reimbursement, cross-state provider licensure, and Indian Health Service billing are built into the standard workflow.
Focus states: Colorado, Utah, Idaho, Wyoming, Nevada
New York Medicaid Managed Care, Massachusetts MassHealth ACO reconciliation, and New Jersey FamilyCare plan mix. Commercial payer density is highest in the country here, so underpayment recovery and contract variance auditing drive the largest share of recovered revenue.
Focus states: New York, Massachusetts, New Jersey, Connecticut, Maryland