Revenue cycle management services
Most practices lose up to 25% of revenue to billing errors. Yours does not have to.
A practice can submit every claim correctly and still collect only 93 cents of every dollar billed. On 1.5 million a year, that is 60,000 dollars earned, billed, and never collected. That gap builds across eligibility errors, undercoding, unworked denials, unreviewed remittances, and AR aging past recovery.
MedHeave closes that gap by managing every stage of your revenue cycle as one integrated operation. AAPC-certified coders review every claim at a first pass rate above 90 percent. Denials are worked within 72 hours. Remittances are reconciled against contracted rates, and AR is held under 40 days. When a payer underpays, it goes back with documentation attached. The result is a net collection rate above 97 percent, turning more of your earned revenue into collected revenue.
Our operational footprint
These aren't aspirational targets.
These metrics are what we deliver, consistently, across all practices and specialties we work with.
90%+
First-pass rate
97%+
Net collection rate
Under 10%
Denial rate
Under 40
AR Days
Your revenue cycle has more gaps than your billing reports show.
From the moment a patient schedules an appointment to the moment payment is posted, every handoff in your revenue cycle is a point where revenue can leak.
- A prior authorization was missed.
- A denial that sits untouched past its filing window.
- A claim was rejected at the clearinghouse.
- A provider NPI that terminates with a major payer and freezes weeks of reimbursements.
MedHeave manages your complete revenue cycle as one connected workflow, from eligibility verification and prior authorizations before the visit, to claim submission, denial management, and final payment posting after it. When every stage is managed by the same team, the likelihood of you losing your revenue to these gaps drops significantly.
What your billing reports are not showing you.
Most practices do not discover billing problems through their billing software. They discover them through their bank statement. By the time cash flow becomes the signal, the revenue loss is already months deep and impossible to recover.
A denied claim without follow-up is revenue you will never recover
Commercial payers give you roughly 90 days to rework or resubmit a denied claim. Medicare gives you up to a year. But most in-house billing teams and understaffed RCM companies batch their denial reviews monthly, not daily. By the time a denial is identified, categorized, and acted on, the filing window for a portion of those claims is already closed.
One credentialing error with a major payer can freeze weeks of reimbursements
If a rendering provider’s NPI terminates with a payer, every claim submitted under that NPI during that period will be rejected. To make it worse, this is hardly ever caught immediately. In the meantime, claims accumulate, cash flow drops, and the practice has no visibility into why. That’s why monitoring credentialing status is an ongoing task, not a one time thing.
Most practices only discover billing gaps when cash flow becomes a problem
Practices often keep billing in-house to control costs, and the problems aren’t obvious at first. Incorrect payer IDs, clearinghouse rejections, data entry mistakes, and missed follow-ups quietly compound. By the time collections fall short months later, the team is trying to fix the workflow while clearing a growing backlog, and most in-house teams lack the capacity to do both.
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Our RCM services
Every part of your revenue cycle is managed by an integrated billing department.
Most billing gaps do not happen because one thing went wrong. They happen because when a claim gets denied or a code gets flagged, there’s no system in place to catch it, correct it, resubmit it, and most importantly, prevent it from happening again. We eliminate that risk by managing your complete revenue cycle as one connected workflow, with accountability at every stage.
Patient registration and demographics
Accurate patient data is the foundation every claim depends on, and errors at this stage lead to avoidable rejections downstream. With our rcm services, we capture and verify demographics at registration so insurance IDs, dates of birth, and payer details are correct before the patient is seen.
Eligibility check & verification of benefits (VOB)
Once patient information is in place, we verify eligibility and benefits before the visit. This includes confirming active coverage on the date of service, understanding what the payer covers, and identifying patient responsibility, so there are no surprises at the claim stage, and expectations are clear upfront.
Prior authorization
Our revenue cycle management services manage the full auth workflow, submitting requests, tracking approvals, monitoring expiration dates, and handling retro-authorization requests when a service was rendered without a completed auth. If an authorization is denied, we evaluate every available appeal option, including medical necessity appeals and peer-to-peer review, before the provider is notified that the authorization cannot be obtained.
Patient scheduling and appointment management
For practices that allow us to manage front-end scheduling workflows, we coordinate patient intake so that the right insurance information, referral documentation, consent forms, and patient details are collected before the appointment. This prevents last-minute eligibility surprises and reduces front-desk bottlenecks on the day of the visit.
Medical coding
Every claim is coded by AAPC-certified coders (CPC, CRC, CPMA, CIRCC, CCC certified) who specialize in your practice’s specific service lines. We apply accurate ICD-10, CPT, and HCPCS codes based on your documentation and specialty-specific coding rules. We do not use generalist coders across all specialties. Your account is handled by coders who bill your specialty every day.
Medical coding audit
We audit your existing coding to identify undercoding, upcoding, and compliance risks. Undercoding is as costly as denials; it just hides better. If you are routinely billing lower-level E/M codes when documentation supports higher ones, you are leaving reimbursement on the table every single day. At the same time, overcoding exposes your practice to audits, penalties, and compliance action that can impact both revenue and reputation.
Medical billing
Accurate medical billing is critical for efficient revenue cycle management. We manage the full billing cycle from claim preparation and submission to patient statements, secondary billing, and payer follow-up. Every claim goes out clean, AR aging is tracked, and nothing is left in the queue without an action
assigned to it.
Clinical documentation improvement
We work with you to align clinical documentation so that every service rendered is fully supported and billable. If documentation does not justify the code billed, the claim will be denied or downcoded. We close that gap proactively, before the claim goes out.
Charge entry and claim scrubbing
Every billable service is entered, reviewed, and reconciled before a claim is submitted. We track every billing batch to confirm it was submitted and passed through the clearinghouse successfully. If a batch is missed, we catch it through a charges audit and resubmit immediately, so it does not affect your collections.
Clearinghouse tracking and rejection resolution
Our RCM services maintain a first pass rate above 90% FPR by tracking every claim through the clearinghouse before it reaches a payer. Claims rejected at this stage are identified and corrected immediately so they can be resubmitted within the same billing cycle, before they have a chance to delay your reimbursements.
Revenue integrity
We ensure that nothing performed in your practice goes undocumented, undercoded, or unbilled. Every service rendered is captured accurately in the charge entry, and every CPT code applied reflects the full scope of the procedure, because our review process is embedded in your workflow before a claim is ever submitted.
Remittance processing
ERAs and EOBs are posted accurately and matched against contracted payer rates for every remittance received. When a payer pays less than what was agreed, we flag and act on it immediately. Underpayments left unreviewed do not stay small; they compound and erode your net collection rate over time.
Accounts receivable management
The 120-plus-day aging bucket is where revenue goes to die. Once a claim crosses that threshold, the likelihood of collection drops sharply, and most practices never recover it. We treat AR days as a performance metric, not just a report line, and hold them under 40 days. Every outstanding balance is followed up on systematically, prioritized by payer, aging bucket, and filing deadline. Our AR teams work by specialty and by state, following payer-specific timelines so that nothing ages past its rework window.
Denial management
We identify approximately 90% of denials directly through ERA responses. Every denial is worked within 72 hours, not batched for weekly or monthly review. Around 70% of denials are resolved with a modifier correction or a minor claim adjustment. The remaining 30% require input from the practice, documentation, authorization details, or clinical clarification, which we flag immediately via email with full context so you can respond quickly. If a corrected claim is denied again, we file an appeal. If the appeal is denied, we will discuss write-off with you before closing the claim.
Credit balance resolution
We identify and resolve credit balances to keep your accounts accurate and audit-ready. This means reconciling overpayments and correcting charge-payment mismatches. It also ensures patient responsibility is properly assigned after claim processing, so balances don’t carry forward incorrectly. Left unresolved, these credits create compliance risk and misstate your financials.
Provider enrollment and credentialing
Credentialing is not a one-time setup; it requires ongoing monitoring to protect your revenue. We manage payer enrollment so you are credentialed, active, and billable across every network in which they participate. If your NPI is at risk of terminating with a payer, we initiate the re-enrollment process ahead of time and notify you before it has any impact on your claims.
Revenue cycle process automation
We implement EFT setup with every payer that supports it and automate ERA retrieval so payment posting is not dependent on manual document handling. Automation reduces manual data entry errors, speeds up remittance processing, and removes the administrative burden from your practice entirely.
Specialties we serve
We know your specialty because we bill for it every day.
Generic billing gets generic results. Our revenue cycle management services work within your specialty’s coding structure, payer requirements, and compliance standards.
Behavioral health
In behavioral health, missing eligibility or session tracking can cost several visits, not just one. We stay ahead of authorization limits, benefit caps, telehealth rules, and co-pay terms so billing stays steady through care.
Podiatry
For podiatry billing, we make sure modifiers like 25 and RT/LT are accurate, services align with global periods and payer edits, and orthotics always meet payer-specific authorization and DME requirements before claims go out.
Urgent care
We handle urgent care billing across walk-ins, diagnostics, and procedures. From there, we track payor coding rules, facility contracts, prior authorizations, and eligibility checks so claims never get delayed, cut, or denied.
Orthopedic
We handle orthopedic billing, making sure procedures get authorized upfront and modifiers like LT/RT and bilateral get applied well. Surgical cases with implants are coded and billed the way payers actually expect for payment.
Cardiology
Cardiology billing often triggers NCCI edit denials, bundling issues, and global period violations when E/M services and procedures are billed together. We manage coding and modifier logic to reduce denials and boost payments.
DME
DME billing is handled by aligning orders, documentation, and delivery timelines with payer rules. We apply HCPCS coding, manage capped rentals, and enforce refill limits so claims are never denied for missing paperwork today.
Pediatrics
In pediatrics, we handle well visits and immunizations, making sure vaccine administration and VFC eligibility are correct. Age-based coding stays accurate as well, so nothing gets missed, underbilled, or delayed at any visit.
Anesthesia
The accuracy of anesthesia billing depends on capturing start and stop times correctly. We ensure precise time capture, apply base units and modifiers, and handle medical direction & concurrency so each unit is billed right.
Don’t see your specialty? We likely work in it.
Our process
From your first call to a fully running revenue cycle.
Providers stay in their current, often flawed revenue cycle management setup longer than they should because trusting someone new with the financial backbone of a practice feels overwhelming. We make that transition structured and transparent, with a clear onboarding process that protects revenue from day one.
Free RCM audit
We review your 60-plus-day aging bucket, top payer balances, major denial patterns, credentialing status, and coding accuracy. You know exactly where your revenue is leaking before we take charge of your billing setup.
Onboarding & setup
For new practices, we start with credentialing, then EHR/EMR setup, EDI connections for federal payers, and coding review before the first claim goes out. For running practices, we audit your existing setup, identify gaps, and begin billing without interrupting your ongoing operations.
Backlog cleanup
From day 1 to 30, we identify every claim within its filing window and prioritize accordingly. Commercial payers allow 90 days, and Medicare allows one year. We clear your denial backlog before any window closes.
Active claims management
During days 30 to 60, submission is timely, denials are actioned within 72 hours, and your billing workflow runs without backlog. This is where the cycle stabilizes and starts performing consistently.
Performance and optimization
Your KPIs start aligning with benchmarks from day 60 to 90. First pass rate exceeds 98 percent. Days in AR fall below 40. Net collection rate reaches 97% or higher. You receive weekly and monthly reports, keeping you informed at every stage.
Performance monitoring
We do not wait for you to notice a problem.
Most revenue cycle management problems surface when a practice owner sees a drop in collections. By then, the root cause is weeks or months old. We track a specific set of metrics on a rolling basis, so underperformance is identified and diagnosed before it affects your cash flow.
How we measure your revenue cycle health
Every month, we measure what your practice actually collected against what was billed. We then compare that number against the previous six months. If your current percentage is tracking at or above the prior period, your revenue cycle is performing as expected. Every month, we measure what your practice actually collected against what was billed. We then compare that number against the previous six months. If your current percentage is tracking at or above the prior period, your revenue cycle is performing as expected. If it is trending below, we do not just report the gap and wait for instructions. We run an internal performance analysis to isolate exactly where the underperformance is coming from before we bring it to you.
If the gap is on the charges side
Rendered services are not being fully reflected in coding or billed at the correct charge amount. This points to charge entry gaps, undercoding, or missed billable encounters that need to be identified and corrected at the front end of the cycle.
If the gap is on the payments side
Claims are going out but not coming back at expected rates. This points to denial patterns, underpayments from specific payers, or AR that is aging without follow-up. The fix is in denial management and payer-specific follow-up, not in the coding or charge entry workflow.
You get findings and a corrective action plan, not a report and an explanation.
When we identify a performance gap, we present what caused it, which part of the cycle it came from, and what is being done to correct it.
Why MedHeave
Your revenue is not a ticket in our queue. It’s our responsibility.
We have seen what happens when revenue cycles are managed carelessly. Everything we do is built around making sure it does not happen to your practice.
Certified medical coders on every account
We have AAPC-certified coders (CPC, CRC, CPMA, CIRCC, CCC), who ensure your claims are coded right the first time, not corrected after a denial.
Direct communication instead of a support queue
Every practice at MedHeave has two dedicated account managers who know their account inside out. You will never be routed through a support line or asked to explain your situation to someone new.
72-hour corrective action
We do not batch denials for monthly review. Every denied claim is identified and worked on within 72 hours, because delayed follow-up is delayed revenue.
SOP-guided operations
Every process we run is documented, supervised, and repeatable. Each team operates under a dedicated supervisor, and our SOPs ensure that a staffing change on our end never causes billing disruption on yours.
Percentage-based pricing
Our fee is calculated as a percentage of what you collect. We do well only when your practice does.
HIPAA compliant across every workflow
From EHR access to payment posting, patient data security is treated as a priority and maintained across all our processes.
Serving practices across 30+ states
Whether you are a solo practice or a multi-location group, we have the infrastructure to manage your billing at scale.
What happens when something goes wrong.
Every billing operation runs into exceptions. What separates a good RCM partner from a bad one is not whether problems occur; it is how fast they are caught and what happens next.
A billing batch was not submitted
We conduct an immediate charges audit to identify which claims were not submitted. We resubmit those claims and track them through the clearinghouse to confirm successful receipt. You are notified of what happened, what was affected, and what has been done. You do not find out about a missed batch from your bank statement.
A provider's NPI terminates with a major payer
We actively track enrollment status and initiate re-enrollment before disruptions occur. If a lapse is identified (especially during transition), we immediately begin re-enrollment and identify all affected claims. Those claims are held or rerouted as appropriate while enrollment is restored, ensuring you are not left out-of-network longer than necessary, and revenue impact is clearly managed.
A payer changes its reimbursement policy or fee schedule
We monitor payer updates and adjust charge amounts proactively. We bill at 150% to 300% of the insurance allowable rate as a standard practice to ensure that fee schedule changes do not result in claims where the billed amount equals or falls below the new allowable, which would reduce reimbursement unnecessarily.
Revenue performance falls without an obvious reason
We run a CPA report comparing payment-to-charge percentages across the previous six months against the current six months. This isolates whether the issue is on the charges side, services not being captured or coded correctly, or the payments side, denials, underpayments, or collections gaps. We present findings with a clear action plan, not a general explanation.
FAQs
Questions we often hear from providers like you.
These are the questions our operations team gets asked on every discovery call by providers that want to know exactly how their revenue cycle will be managed before they partner with us.
How is MedHeave's pricing structured?
We work on a percentage-of-collections model. You pay based on what we actually collect for your practice. No flat fees, hidden charges, or lock-in agreements. We do not charge you for claims that are never paid (although the likelihood of unpaid claims is very low).
How long does it take to get started?
For established practices, we review your billing within the first week. For new practices, a full setup, including billing software configuration and EDI connections, is completed within four weeks.
We already use another billing company. How do we switch?
We manage the entire transition. We request access from your previous billing company and begin working with what we can access immediately. If access is withheld or delayed, which happens frequently, we rebuild portal access independently so your billing is not held hostage to a non-cooperative handover. Outstanding claims are audited, recoverable balances are worked, and your billing is stabilized without interruption to your revenue flow.
Do you handle prior authorizations?
Yes. We manage auth requests, track approvals, and handle retro-authorizations when needed. If an auth is denied, we evaluate every appeal option, including medical necessity appeals, before writing anything off.
Can you handle billing across multiple states?
Yes. We have a team well-versed in state and payer-specific rules and can manage billing across all 50 states, each following state-specific payer rules, filing deadlines, and documentation standards.
What reports will we receive?
Weekly charge and payment reports and monthly AR summaries are standard. If you need a different format or reporting frequency, we accommodate that without question.
What EHR and billing systems do you work with?
We work with most major EHR and practice management platforms. At onboarding, we assess your current system and integrate directly. If you are a new practice without a system in place, we configure the billing software, establish EDI connections, and set up EFT with every eligible payer before your first claim goes out.
How do you protect our revenue if someone on your team leaves?
Every team member operates under documented SOPs. Departures require a 30-day notice period during which full account handover is completed. If a departure is immediate, the team supervisor assumes direct responsibility for your account from day one. Your day-to-day billing activities do not depend on any individual.
How do you handle payer-specific rules and timely filing deadlines across different states?
Each of our dedicated teams follows documented SOPs that outline payer-specific filing deadlines, documentation requirements, and coverage rules for the states and specialties they support. These SOPs are maintained and updated as payer policies change. Filing deadline management is built into our AR workflow; nothing ages past its rework window without a follow-up action already in motion. We ensure that claims are submitted within 48 to 72 hours of the date of service.
You have already earned this money.
Let us help you collect it.
A free audit takes less than 24 hours to schedule and gives you a complete picture of what your billing cycle is missing.
