End-to-end revenue cycle management
One partner for the entire cycle, from the moment an appointment is booked to the moment the balance clears. Nothing falls between vendors.
The problem this fixes
Practices often solve the revenue cycle in pieces — software for claims, a service for coding, a person for A/R, nobody for denials. Every handoff between those pieces is a place where a claim can stop moving, and no single party is accountable for the outcome.
There is a second cost, harder to see. When no single party owns the outcome, every party optimises its own stage. The coding vendor improves accuracy, the clearinghouse improves acceptance, the A/R person improves touches per day — and days in A/R does not move, because the constraint was somewhere none of them were looking.
What goes wrong when this is done badly
Four failure modes we see repeatedly, and each one is a process problem rather than an effort problem.
Splitting the cycle across vendors
Software for claims, a service for coding, a person for A/R, nobody for denials. Every handoff is a place a claim can stop moving, and no single party is accountable for the number at the end of the month.
Measuring one stage in isolation
A clean claim rate improves while days in A/R gets worse, because the claims that used to be rejected are now being denied instead. Stage-level metrics without a cycle-level view produce exactly this.
Front-end failures blamed on the back end
Most denials that look like billing problems started at registration. Fixing them in appeals is possible and expensive; fixing them at check-in is neither.
Reporting nobody reads
A monthly pack of thirty charts is not visibility. If the practice owner cannot state the denial rate and days in A/R from memory, the reporting has failed regardless of how thorough it is.
What's included
Every item below is a deliverable, not a capability statement.
Patient access
Registration accuracy, insurance capture, eligibility verification, and prior authorisation.
Charge capture
Every service performed is recorded and reconciled against the schedule.
Coding
Diagnosis and procedure coding by certified specialty coders.
Claim submission
Scrubbing, edits, electronic submission, and clearinghouse management.
Payment posting
ERA/EOB posting, contractual adjustment, and underpayment detection.
Denials and A/R
Root-cause analysis, corrected claims, appeals, and ageing-based follow-up.
Patient balances
Statements, payment plans, patient support, and pre-collection outreach.
How it works
- 1 Patient access Registration accuracy, insurance capture, eligibility verification, prior authorisation. Front-end.
- 2 Charge capture Every service performed is recorded and reconciled against the schedule. Mid-cycle.
- 3 Coding Diagnosis and procedure coding by certified specialty coders. Mid-cycle.
- 4 Claim submission Scrubbing, edits, electronic submission, clearinghouse management. Mid-cycle.
- 5 Payment posting ERA/EOB posting, contractual adjustment, underpayment detection. Back-end.
- 6 Denials and A/R Root-cause analysis, corrected claims, appeals, ageing-based follow-up. Back-end.
- 7 Patient balances Statements, payment plans, patient support, pre-collection. Back-end.
Reference
| Metric | Industry benchmark | Why it matters |
|---|---|---|
| First-pass clean claim rate | 95%+ (top performers 98–99%) | Every rejected claim costs $25–30 to rework and adds 14–21 days |
| Days in A/R | 30–40 days (top performers under 25) | Direct measure of cash flow speed |
| Denial rate | Under 8% | Above this, revenue leakage is structural |
| Net collection rate | Above 95% of collectable | How much of what you earned you actually keep |
| A/R over 90 days | Under 20% of total | Concentration here signals systemic follow-up failure |
| Cost to collect | 3–4% of net patient revenue | Total cost of running the cycle |
What you get back
- Weekly operational reporting across the whole cycle, not one stage of it
- Monthly financial reporting with payer-level breakdown
- A named account lead accountable for the outcome end-to-end
- One vendor, one set of numbers, no handoffs between suppliers
Who this is for
- Practices currently splitting the cycle across several vendors
- Practices where nobody owns the number at the end of the month
- Growing groups adding providers, locations or payer contracts
- Practices that want to start with denials and A/R and expand from there
What we measure
The numbers this service actually moves. You see all of them weekly, in your own system, with the benchmark alongside.
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Cost to collect Total cost of running the revenue cycle as a percentage of net patient revenue. Benchmarks sit at 3 to 4%. It is the only figure that compares an in-house operation and an outsourced one on the same basis.
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A/R over 90 days The share of receivables aged past 90 days. Under 20% is healthy. Concentration here means follow-up is reaching new claims and abandoning old ones, which an average days-in-A/R figure will hide.
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Point-of-service collection rate Patient responsibility collected at the desk rather than chased through statements. It is the cheapest money in the cycle and the most commonly ignored.
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Charge lag Days between the date of service and the charge reaching the claim. Every day here is a day added to days in A/R before a payer has even seen the claim.
Benchmark ranges are sourced from MGMA and HFMA MAP Keys. MedBil's own figures are published only with a stated measurement window, per specification section 12.7.
Where this matters most
The specialties where this part of the cycle carries the most risk and the most recoverable revenue.
Start with your own numbers
We measure your denial rate, A/R ageing and net collection rate against industry benchmarks before you commit to anything. You keep the analysis either way.
- 90 days of claims data, no patient identifiers needed
- A written analysis, not a sales deck
- No contract, and no obligation to proceed
- Client results published with a stated measurement window, once available
Questions about revenue cycle management
What's the difference between medical billing and RCM?
Billing is claim submission and follow-up. RCM covers the full financial lifecycle, starting before the patient arrives.
Can I take only part of the cycle?
Yes. Many practices start with denials and A/R and expand from there.
How often will I see reporting?
Weekly operational reporting, monthly financial reporting.
Who is accountable if something goes wrong?
A named account lead. One person owns the outcome across the whole cycle rather than one stage of it.
Related
Where this connects to the rest of the cycle.
Provider Credentialing & Payer Enrollment
Payer enrollment, CAQH management, re-attestation, and contract negotiation.
See provider credentialingDenial Management & Appeals
Root-cause analysis, corrected claims, and clinical appeals filed inside payer deadlines.
See denial managementAccounts Receivable Recovery
We work aged and legacy receivables other billers gave up on.
See A/R recovery