Full-cycle medical billing and revenue cycle management for U.S. hospitals, critical access hospitals, rural health clinics, FQHCs, community hospitals, physician groups, and specialty clinics. Patient access through final payment, one accountable partner, 24/7 operations.
RCMGen runs continuous revenue cycle operations for US hospitals and clinics — clean submissions, denial resolution, A/R recovery, and payment posting that move while your competitors wait for Monday morning. Faster cash. Fewer write-offs. Zero overnight stalls.
Most providers leak revenue because their billing vendor handles part of the cycle and blames the rest on the provider. We own the entire flow from the first patient appointment to the final dollar posted, with documented handoffs and accountability at every stage.
Patient access and pre-registration
Scheduling integration, demographic capture, insurance eligibility verification, prior authorization management, financial counseling, and point-of-service collections setup.
Insurance eligibility verification
Real-time eligibility checks 72 hours, 48 hours, and 24 hours before service. Benefits detail capture, deductible tracking, copay calculation, and coordination of benefits verification.
Prior authorization management
End-to-end prior authorization workflow including clinical documentation submission, payer portal management, peer-to-peer coordination, authorization tracking, and expiration monitoring.
Medical coding services
AAPC and AHIMA certified coders across ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, and DRG assignment. Inpatient, outpatient, emergency department, ambulatory surgery, and physician coding covered with two-level QA.
Charge capture management
Charge reconciliation against clinical documentation, missed charge identification, chargemaster (CDM) maintenance, and service line profitability analysis.
Claims submission management
Payer-specific claim scrubbing, clearinghouse configuration, electronic claim submission, rejection management, and same-day resubmission workflows with a target clean claim rate above 95 percent.
Payment posting and reconciliation
Electronic remittance advice (ERA) posting, manual EOB entry, contractual adjustment validation, underpayment flagging, and daily bank deposit reconciliation.
Denial management and appeals
Root-cause denial analysis, payer-specific appeal templates, first and second level appeals, external review coordination, and denial prevention loop back to coding and front end.
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.
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.
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, 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.
