End-to-end revenue cycle management for community hospitals, critical access hospitals, rural emergency hospitals, and regional health systems. DRG validation, inpatient and outpatient coding, chargemaster management, 340B billing, clinical documentation integrity, denial management, and A/R recovery, all delivered under one contract with one accountable partner.
End-to-end revenue cycle management for community hospitals, critical access hospitals, rural emergency hospitals, and regional health systems. DRG validation, inpatient and outpatient coding, chargemaster management, 340B billing, clinical documentation integrity, denial management, and A/R recovery, all delivered under one contract with one accountable partner.
Critical access hospital (CAH) billing
Revenue cycle management for CAHs with Method II billing, swing-bed coding, 96-hour rule compliance, and cost report reconciliation built into every claim.
Rural emergency hospital (REH) billing
Revenue cycle management for REHs covering monthly facility payment reconciliation, outpatient-only service rules, and transition-year cost report filings.
Community hospital billing
Revenue cycle management for 25 to 250 bed community hospitals covering DRG validation, observation status audits, and commercial contract variance recovery.
Regional health system billing
Revenue cycle management for multi-facility regional health systems covering centralized patient access, enterprise denial management, system-wide KPI governance, and consolidated A/R recovery workflows.
Orthopedic specialty hospital billing
Revenue cycle management for orthopedic specialty hospitals covering joint replacement coding, implant carve-out reconciliation, global period tracking, and surgical bundle payment management.
Rehabilitation hospital billing
Revenue cycle management for inpatient rehabilitation facilities (IRF) covering PPS compliance, 60 percent rule documentation, functional assessment scoring, and CMG grouping accuracy on every admission.
Psychiatric hospital billing
Revenue cycle management for psychiatric and behavioral health hospitals covering IPF PPS billing, concurrent care rules, parity law enforcement, and commercial and Medicaid MCO authorization workflows.
Children's hospital billing
Revenue cycle management for children's and pediatric specialty hospitals covering pediatric DRG accuracy, NICU billing complexity, CHIP reimbursement rules, and Medicaid MCO pediatric authorization workflows.
Long-term acute care hospital
Revenue cycle management for LTACHs covering 25-day average length of stay compliance, site-neutral payment rules, LTCH-PPS grouping accuracy, and transfer billing reconciliation with referring facilities.
We cover the full hospital revenue cycle from patient access through final account resolution. Each component is staffed by hospital-specific specialists, not generalists.
Patient access and pre-registration
Registration accuracy, insurance eligibility verification, prior authorization, medical necessity validation, price estimation, and point-of-service collections for inpatient admissions, emergency department visits, and outpatient services.
Inpatient coding
ICD-10-CM and ICD-10-PCS coding by AHIMA-certified inpatient coders (CCS, CIC). DRG assignment, present-on-admission (POA) indicator accuracy, hospital-acquired condition (HAC) tracking, and complication or comorbidity.
Outpatient and ambulatory surgery
Outpatient and ambulatory surgery coding: APC grouping, modifier 25, 26, 27, 50, 58, 59, 78, 79 application, observation billing, condition code accuracy, and ASC payment indicator grouping for hospital outpatient departments.
Emergency department coding
E/M leveling accuracy (99281 through 99285), critical care time documentation, trauma activation billing, facility fee capture, and observation versus admission status validation.
Clinical documentation integrity
Concurrent and retrospective CDI review, physician query workflow, CC/MCC capture optimization, DRG assignment accuracy, and HCC capture coordination for value-based contracts.
Denial management and appeals
Clinical denial appeal with physician-advisor coordination, medical necessity appeals with LCD and NCD citation, observation downgrades, and level-of-care disputes.
Chargemaster management
Chargemaster (CDM) maintenance, quarterly pricing review, new service line charge structure setup, modifier and revenue code accuracy, and compliance with OPPS updates.
Underpayment recovery
Underpayment recovery and contract variance Payer contract modeling, line-item underpayment identification, expected reimbursement validation, and formal underpayment recovery.
Accounts receivable follow-up
Age-based A/R workflow, payer follow-up cadence, no-response escalation at day 30 and day 45, high-dollar claim prioritization, and small-balance write-off governance.
Patient financial services
Patient statement generation, online payment portal, payment plan management, propensity-to-pay scoring, self-pay follow-up, and pre-collection triage.
Reporting, analytics, and KPI
Real-time dashboards, monthly executive business reviews, payer scorecards, physician productivity reporting, service line profitability, and custom KPI alignment to your board report format.
Credit balance refund management
Credit balance identification from payer overpayments and duplicate patient payments, root-cause analysis to prevent recurrence, automated refund workflow to payers and patients.