Revenue Cycle Management Services for Medical Practices
Get paid in full, and on time, for the care you give. MediFlows manages every step from patient check-in to final payment for one flat fee, so your team can focus on patients instead of paperwork.
- * MAXIMIZE REVENUE
- * REDUCE CLAIM DENIALS
- * IMPROVE CASH FLOW
- *EXPERT MEDICAL BILLING
- * EXPERT RCM SERVICES
- *END-TO-END RCM SUPPORT
- * MINIMIZE CLAIM DENIALS
- *IMPROVE COLLECTIONS
What Is Revenue Cycle Management?
Revenue cycle management is the full financial process behind every patient visit. It starts when a patient schedules an appointment and ends when your practice collects the last dollar for that visit, from the insurance company and from the patient.
In between, a lot has to go right. The patient’s insurance has to be active. The service may need a prior authorization. The provider’s notes have to support the codes. The claim has to match each payer’s rules. Payments have to be posted correctly, and every denial has to be fixed and resubmitted before the filing deadline.
When one step is missed, the claim is delayed or denied. Multiply that by hundreds of claims a month, and small mistakes turn into a large amount of lost revenue. Good healthcare revenue cycle management connects every step, so problems are caught early instead of discovered months later in an aging report.
Many practices don’t realize how much they’re losing until they look closely. If any of these sound familiar, your revenue cycle needs attention:
- Your denial rate keeps climbing. The same denial reasons show up month after month, and nobody has time to fix the root cause.
- A/R over 90 days keeps growing. Old claims sit unworked because your team is busy with today's claims.
- Payments are slower than they used to be, even though patient volume is the same or higher.
- Your staff spends hours on hold with payers instead of helping patients at the front desk.
- You don't get clear reports. You can't easily answer how much you collected last month, or why claims were denied.
- Coding changes every year and your team struggles to keep up with new CPT, ICD-10 and payer policy updates.
- Staff turnover disrupts billing. When your biller leaves or takes time off, claims stop going out.
Complete Revenue Cycle Management, From Check-In to Final Payment
Our RCM services cover all three stages of the revenue cycle. You can outsource the whole cycle or only the parts where you need help.
Front end: before the visit
Insurance eligibility and benefits verification. We confirm each patient’s coverage, copay, deductible and plan limits before the appointment, so eligibility denials stop before they start. Learn about our insurance eligibility verification services.
Prior authorization support. We request, track and follow up on prior authorizations for procedures, imaging and specialty drugs, so treatment isn’t delayed and claims aren’t denied for missing approval.
Patient registration review. We check demographics, policy numbers and subscriber details for errors that cause rejections. Small typos are one of the most common reasons claims come back.
Middle: coding and claims
Medical coding. Certified coders assign accurate CPT, ICD-10-CM and HCPCS codes and modifiers based on your documentation. Correct coding means you’re paid for the full level of care you gave, without compliance risk.
Charge entry and claim scrubbing. Every charge is entered and checked against payer rules and NCCI edits before submission, to raise your clean claim rate.
Electronic claim submission. Claims go out daily through your clearinghouse. We track every claim until the payer accepts it and fix rejections the same day. See our medical billing services.
Back end: getting paid
Payment posting. We post ERA and EOB payments, adjustments and patient responsibility accurately, so your books match what payers actually paid.
Denial management and appeals. We find out why each claim was denied, correct and resubmit it, and write appeals when needed. We also track denial patterns so the same problem doesn’t keep happening. Explore denial management services.
Accounts receivable follow-up. Our A/R team works unpaid and underpaid claims by age and dollar value, calling payers and escalating when needed, to bring your A/R days down.
Patient statements and balance follow-up. Clear patient statements and polite follow-up help you collect patient balances without hurting relationships.
Credentialing and payer enrollment. New provider or new payer? We handle CAQH, Medicare, Medicaid and commercial enrollment so you can bill from day one.
The Revenue Leaks Our RCM Team Fixes
Most lost revenue comes from a small number of repeat problems. Our team tracks every denial by its reason code, fixes the claim, and then fixes the process that caused it.
| Denial Code | What It Means | How We Prevent It |
|---|---|---|
| CO-16 | Claim is missing information or has errors. | ✓ Claim scrubbing checks every field before submission. |
| CO-22 | Another payer may be primary (coordination of benefits). | ✓ We confirm primary and secondary coverage at eligibility check. Read our CO-22 denial code guide → |
| CO-29 | Filing deadline has passed. | ✓ Daily claim submission and tracking against each payer’s timely filing limit. |
| CO-50 | Payer says the service wasn’t medically necessary. | ✓ Coders check that diagnosis codes support the procedure, and we appeal with records when needed. |
| CO-197 | Prior authorization was missing. | ✓ We check authorization rules before the visit and track approvals. |
| CO-18 | Duplicate claim. | ✓ Every resubmission is tracked, so the same claim isn’t sent twice. |
Beyond denials, we also catch underpayments (when a payer pays less than your contracted rate), missed charges (services given but never billed) and uncollected patient balances. These leaks don’t show up as denials, so many practices never see them.
How Our RCM Services Work
Switching billing partners shouldn’t disrupt your cash flow. Here’s how we get started:
Free revenue audit.
We review a sample of your claims, denials and A/R to find where money is being lost. You get a plain-English report, whether or not you work with us.
Custom plan and flat-fee quote.
Based on the audit, we recommend the services you need and give you one clear monthly price. No hidden fees.
Secure setup.
We sign a Business Associate Agreement (BAA), get secure access to your EHR, practice management system and clearinghouse, and learn your payer mix and workflows.
Go live with a dedicated team.
Your account manager, coders and billers take over daily claims, posting and follow-up. We also start working your existing A/R backlog right away.
Monthly reports and reviews.
Every month you get a clear report on collections, denials, A/R days and clean claim rate, plus a call to review results and next steps.
In-House Billing vs. Outsourced Revenue Cycle Management
Many practices start with an in-house biller. As the practice grows, that setup gets harder to manage. Here’s how the two options compare:
| CATEGORY | IN-HOUSE BILLING | MEDIFLOWS OUTSOURCED RCM |
|---|---|---|
| Cost | Salaries, benefits, training, software and office space | ✓ One flat monthly fee |
| Coverage | Stops when a biller is sick, on leave or quits | ✓ A full team, so claims go out every business day |
| Expertise | Depends on one or two people | ✓ Certified coders, billers and A/R specialists by specialty |
| Coding Updates | Your staff must learn yearly changes on their own | ✓ Our team is trained on every CPT, ICD-10 and payer update |
| Denial Follow-up | Often falls behind when the office is busy | ✓ Every denial is worked, tracked and trended |
| Reporting | Often basic or manual | ✓ Detailed monthly reports and a review call |
| Scaling | Growth means hiring and training more staff | ✓ We add capacity as you add providers and locations |
Outsourcing doesn’t mean giving up control. You keep full access to your systems and data, and you can see every claim and payment at any time. Your in-house staff can then focus on patients, scheduling and front-desk work.
Switching From Another Billing Company Without Losing Revenue
Many practices come to us after a bad experience. Their billing company stopped returning calls, stopped working old claims, or couldn’t explain where the money went. Others lost their only in-house biller, and claims stopped going out overnight.
Changing billing partners can feel risky. With a planned handoff, it doesn’t have to be. Here’s how we protect your cash flow during the switch:
Full snapshot on day one.
We pull a complete A/R and denial report from your system, so no open claim is lost in the handoff.
Deadlines first.
We check every payer's timely filing limit and work the claims closest to their deadline first.
Backlog cleanup.
We correct and resubmit denied claims that can still be paid, and file appeals where they're needed.
No gap in submissions.
New claims keep going out while we clean up the old ones.
Your data stays yours.
Everything stays in your own EHR and practice management system, not ours.
If you’re changing EHR or practice management software at the same time, we’ll plan the billing side of that move with you too.
Every specialty has its own codes, modifiers and payer rules. Our team knows them, so your claims go out right the first time.
| Primary Care | Specialty Care | Therapy & Behavioral Health | Other Services |
| ✓ Family medicine | ✓ Cardiology | ✓ Psychiatry | ✓ Urgent care |
| ✓ Internal medicine | ✓ Orthopedics | ✓ Behavioral health | ✓ Radiology |
| ✓ Pediatrics | ✓ Neurology | ✓ Physical therapy | ✓ Laboratory services |
| ✓ Geriatric | ✓ Gastroenterology | ✓ Occupational therapy | ✓ Home health |
| ✓Preventive Care | ✓ Dermatology | ✓ Chiropractic care | ✓ Remote patient monitoring |
| ✓ General Practice | ✓ Pain management | ✓ Mental Health | ✓ Dental |
Practices we work with
- Solo and small practices that want to stop doing billing after hours
- Growing specialty clinics adding providers, locations or payers
- Multi-provider groups that need one consistent billing process across sites
- New practices that need credentialing and billing set up from day one
- Practices leaving another billing company because of slow payments or poor reporting
- One flat monthly fee. You know your billing cost every month. No surprise charges for appeals, A/R calls or reports.
- One dedicated team. You get a named account manager who knows your practice, not a new person on every call.
- Certified coders. Our coders stay current with yearly CPT, ICD-10 and HCPCS updates and payer policy changes.
- We work in your systems. We use your current EHR, practice management software and clearinghouse. No new software to buy or learn.
- Full transparency. You can see every claim, every denial and every dollar at any time.
- HIPAA compliance. We sign a BAA, use secure access controls and train every team member on patient data privacy.
Medical Billing Performance Dashboard
The numbers we report every month
You’ll always know how your revenue cycle is performing. Each monthly report tracks:
| Metric | What it tells you |
| Net collection rate | How much of the money you’re owed you actually collect |
| Clean claim rate | How many claims are accepted the first time, with no fixes |
| Denial rate | How many claims payers deny, and why |
| Days in A/R | How long, on average, it takes to get paid |
| A/R over 90 days | How much money is stuck in old, unpaid claims |
| First-pass resolution rate | How many claims are paid on the first submission |
We don’t just send numbers. Every report includes what changed, why, and what we’re doing about it.
We submit and follow up on claims with Medicare, Medicaid and commercial insurance plans in all 50 states. Our team knows each payer’s claim rules, filing limits and appeal process, so claims aren’t rejected for avoidable reasons.
- Medicare Part B claims, including Medicare Advantage plans
- State Medicaid programs and Medicaid managed care plans
- Commercial payers such as UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield and Humana
- Secondary and tertiary claims, including coordination of benefits
- Workers' compensation and auto injury claims where your specialty needs them
Find Out How Much Revenue Your Practice Is Leaving Behind
Our free revenue audit shows where your claims are getting stuck, which denials keep coming back and how much A/R you can still collect. There’s no cost and no commitment. You’ll get a clear report either way.
What is revenue cycle management in healthcare?
What is the difference between medical billing and revenue cycle management?
How much do revenue cycle management services cost?
How long does it take to switch to MediFlows?
Is outsourcing revenue cycle management HIPAA compliant?
Can I outsource only part of my revenue cycle?
What happens to my old unpaid claims when I switch?
Do you bill Medicare and Medicaid?
Which EHR systems do you work with?
About Us
Mediflows has been offering comprehensive billing and revenue cycle solutions across a wide range of specialties all over USA.
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Serving All Across The United States