Question 1

What services does your RCM company provide?

Accepted Answer

We provide flexible RCM and medical coding support across the revenue cycle: medical coding, coding audits, clinical documentation improvement (CDI) support, revenue integrity and optimization, billing, accounts receivable (AR) management, claim edits and rejections, denial management, denial prevention, eligibility and benefits verification, prior authorization support, and end-to-end RCM operations. Services can be purchased individually or as an integrated program.

Question 2

Which specialties do you support?

Accepted Answer

Our operating model supports physician practices, specialty groups, hospitals and health systems, ambulatory organizations and other healthcare providers. Specialty coverage is confirmed during discovery, because coding rules, documentation patterns, payer behavior, workflows and staffing requirements vary by specialty.

Question 3

Can we outsource only coding and keep billing in-house?

Accepted Answer

Yes. Services are modular. You can outsource professional or facility coding, coding audit, CDI, billing, AR or denials — or any other defined function — without outsourcing the entire revenue cycle.

Question 4

Can you manage the entire revenue cycle?

Accepted Answer

Yes. An end-to-end model covers front-end, middle-office and back-end functions: eligibility and benefits verification and authorization support; coding and billing; and AR, edits and rejections, denials and denial prevention. Exact scope, systems, staffing model and SLAs are defined during implementation.

Question 5

What technology and EHR/PM systems can you work with?

Accepted Answer

We structure delivery around your existing EHR, practice-management, billing, clearinghouse and payer workflows where technically and contractually permitted. During discovery we confirm system compatibility, required interfaces, access methods, reporting needs and security controls.

Question 6

How quickly can you start?

Accepted Answer

Launch timing depends on scope, payer mix, specialties, system access, data availability, staffing and training. A practical implementation plan includes discovery, workflow mapping, access setup, knowledge transfer, pilot processing, quality validation and phased go-live.

Question 7

What coding services can you provide?

Accepted Answer

Depending on the engagement: professional and/or facility coding, diagnosis and procedure coding, chart review, coding validation, coding quality audits, charge review, specialty-specific coding support and coding education.

Question 8

Do you support ICD-10-CM, CPT and HCPCS coding?

Accepted Answer

Yes. Coding engagements are structured around the applicable code sets and client-specific guidelines. Final scope identifies code sets, specialties, payer requirements and whether modifiers, E/M leveling or other specialty-specific rules are included.

Question 9

Can you perform retrospective coding audits?

Accepted Answer

Yes. Retrospective audits assess coding accuracy, documentation support, modifier use, medical necessity considerations, missed or unsupported codes and recurring education opportunities. Audit methodology and sample size are agreed in advance.

Question 10

Can you support concurrent or prospective coding/CDI workflows?

Accepted Answer

Yes, where your clinical workflow and technology permit. The goal is to identify documentation opportunities early enough to support accurate, complete and compliant claims, rather than relying only on retrospective corrections.

Question 11

How do you handle coding discrepancies?

Accepted Answer

Discrepancies are documented, reviewed against the available clinical record and applicable coding guidance, resolved through a defined escalation path, and used as learning opportunities. Recurring errors trigger targeted education or workflow changes.

Question 12

How do you ensure coding accuracy, and what accuracy should we expect?

Accepted Answer

We use standardized coding workflows, qualified coding resources, documented quality controls, regular audits, feedback loops and targeted education. A single accuracy percentage should not be treated as universal — the right target depends on specialty, code type, sampling method, chart complexity, and whether the metric is first-pass or post-feedback accuracy. Definitions and measurement methodology are agreed before targets are set.

Question 13

What is included in front-end RCM?

Accepted Answer

Typical front-end activities include patient registration support, eligibility and benefits verification, authorization and prior-authorization support, and other pre-service activities agreed in scope.

Question 14

What is included in the middle of the revenue cycle?

Accepted Answer

Middle-cycle functions generally include coding, charge capture support, claim creation and submission, billing workflows, claim edits and rejection management.

Question 15

What is included in back-end RCM?

Accepted Answer

Back-end operations generally include AR follow-up, claim status work, payment posting where included, denial management, appeals, underpayment identification, and denial-prevention and root-cause initiatives.

Question 16

How do you handle denials?

Accepted Answer

We classify denials by root cause, payer, provider, service and workflow stage; prioritize recoverable and high-value accounts; perform timely follow-up; and feed root-cause findings back into upstream processes. The objective is not only to work denials but to reduce preventable ones.

Question 17

Can you work on aged AR, and how is AR prioritized?

Accepted Answer

Yes. Aged AR is segmented by payer, balance, aging bucket, denial status, timely-filing risk and recoverability, then worked through a dedicated queue and recovery strategy. Prioritization considers balance, payer, age, timely-filing deadlines, denial reason, expected recoverability, contractual considerations and your own priorities.

Question 18

Can you help reduce days in AR?

Accepted Answer

Yes. We target the operational drivers of AR days: unworked claims, avoidable rejections, delayed follow-up, unresolved denials, underpayments and front-end issues. Baseline and target definitions are agreed before improvement is measured.

Question 19

Do you follow HIPAA and healthcare data privacy requirements?

Accepted Answer

Our delivery model is designed around applicable privacy, security, confidentiality and contractual requirements. Before production access, the parties establish appropriate agreements, access controls, secure data transfer, user provisioning, auditability and incident-management processes. Final compliance obligations depend on your location, data, systems and contractual structure.

Question 20

How do you protect patient information?

Accepted Answer

Access is role-based and limited to authorized personnel. Delivery uses approved secure systems and transfer methods, with appropriate logging, confidentiality controls, workforce training and incident escalation. Client-specific security requirements are documented before go-live.

Question 21

How is quality monitored?

Accepted Answer

Through production metrics, quality audits, error trending, root-cause analysis, coaching, calibration and periodic management reviews. Dashboards separate productivity from quality so higher volume never masks accuracy issues.

Question 22

Do you provide reports?

Accepted Answer

Yes. Reporting can include productivity, coding accuracy, claim volume, rejection and denial rates, AR aging, inventory, turnaround time, appeal outcomes, root-cause trends and agreed financial KPIs.

Question 23

What happens if quality falls below the agreed target?

Accepted Answer

A documented corrective-action process: identify the cause, validate the sample, coach or retrain, increase quality monitoring where needed, and track recovery against an agreed timeline.

Question 24

How are RCM services priced?

Accepted Answer

Common models include per-claim, per-chart, per-transaction, hourly/FTE, percentage-of-collections, fixed monthly fee or hybrid pricing. The right model depends on volume, complexity, scope, systems, staffing and desired risk allocation.

Question 25

What information do you need to provide a proposal?

Accepted Answer

Specialties, monthly claim/chart volume, payer mix, locations, current staffing, EHR/PM and clearinghouse systems, current KPIs, AR aging, denial profile, coding scope, service-level expectations, operating hours and implementation timeline.

Question 26

Can we start with a pilot?

Accepted Answer

Yes — a pilot reduces implementation risk. A strong pilot defines scope, sample size or transaction volume, baseline performance, success criteria, quality thresholds, reporting and a decision point for expansion.

Question 27

What SLAs should be included?

Accepted Answer

SLAs may cover turnaround time, accuracy, productivity, claim submission timeliness, denial follow-up, response times, reporting frequency, escalation, security and business continuity. Every KPI should have clear definitions and measurement rules.

Question 28

Can you scale with our growth?

Accepted Answer

Yes. Capacity planning is tied to forecasted volumes, new specialties, provider additions, payer changes and seasonal demand. Scaling preserves quality through a controlled training and transition plan.

Question 29

Will you guarantee a certain revenue increase?

Accepted Answer

We prefer measurable, evidence-based commitments over unsupported guarantees. Financial outcomes depend on payer contracts, documentation, coding, patient mix, claim volume, existing workflows and client-side decisions. We establish baseline metrics and agree measurable operational and financial KPIs.

Area	Example KPI	Why buyers care
Coding	Coding accuracy / audit accuracy	Protects compliance and revenue integrity
Coding	Turnaround time	Supports timely billing
Claims	Clean claim / first-pass rate	Reduces avoidable rework
Claims	Rejection rate	Identifies front-end and submission issues
Denials	Denial rate and preventable denial rate	Shows revenue leakage and process quality
AR	AR aging / >90-day AR	Shows cash-flow health
AR	Net collection performance	Connects operations to financial outcomes
Operations	Productivity per FTE / transaction	Shows capacity and efficiency
Service	SLA adherence	Confirms delivery reliability
Quality	QA error trend / corrective actions	Shows continuous improvement

RCM and medical coding, answered for buyers

Services & scope

Medical coding

End-to-end RCM

Quality, compliance & security

Commercial & contracting

The KPI framework we report against

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