End-to-end medical billing and revenue cycle management for solo practitioners, group practices, multi-specialty clinics, specialty centers, and physician-owned networks. Credentialing, coding, claims submission, denial management, A/R recovery, HCC risk-adjusted coding, MIPS reporting, and patient collections, all under one partner with 15 percent of our fees at risk against your KPIs.
RCMGen's physician billing service is configured around those realities. Credentialing, coding, claims, denials, A/R, patient financial services, and quality reporting run as one integrated workflow, not five siloed ones.
Provider credentialing enrollment
CAQH maintenance, Medicare and Medicaid enrollment, commercial payer enrollment, re-credentialing, license monitoring, DEA and CDS tracking, etc.
Eligibility and benefits verification
Real-time eligibility before every visit, benefits capture, deductible tracking, copay calculation, and same-day verification on add-on appointments.
Prior authorization management
Payer portal management, clinical documentation submission, peer-to-peer coordination, authorization tracking with expiration alerts, and appeal workflow.
Medical coding services
AAPC-certified coders (CPC, COC, CRC, CPMA) across 30+ specialties. ICD-10-CM, CPT, HCPCS Level II, modifier application, etc.
Charge entry and charge capture
Daily charge reconciliation against visit schedule, missed charge identification, ancillary service capture, and in-office procedure billing accuracy.
Claims submission and scrubbing
Claim-level scrubbing against NCCI edits, medical necessity rules, payer-specific guidelines. Electronic submission via preferred clearinghouse with same-day.
Payment posting and reconciliation
ERA posting, manual EOB entry, contractual adjustment validation, underpayment flagging, and daily deposit reconciliation to your bank.
Denial management and appeals
Denial root-cause analysis, specialty-specific appeal templates, medical necessity appeals, and feedback loops back to coding and front-office.
Accounts receivable follow-up
Age-based A/R workflow, payer follow-up cadence, no-response escalation at day 30 and day 45, and small-balance write-off governance.
Patient billing and collections
Patient statement generation, online payment portal, payment plan management, propensity-to-pay scoring, automated reminder workflow, and pre-collection triage.
HCC risk-adjusted coding
HCC capture for Medicare Advantage, ACO, and risk-bearing contracts. Annual recapture reviews, suspect condition queries to providers, and RAF score optimization.
Reporting and analytics
Provider-level productivity, payer yield, denial trending, A/R aging, patient collection performance, and monthly financial close support along with weekly strategy meetings.
