The entire revenue cycle. Ten service categories. One accountable team.
From credentialing and eligibility through coding, submission, payment posting, denials, AR, secondary billing, underpayment recovery, and monthly analytics. We run the whole cycle so your team focuses on patients.
Revenue cycle management, explained without the jargon.
Revenue cycle management is the full path a dollar takes from patient scheduling to money in your bank account. It touches eligibility, coding, submission, payer adjudication, denials, patient statements, and reporting. Every step has its own failure mode, and every failure quietly leaves money on the table. RCM is the discipline of making that path predictable.
Front-end → Middle → Back-end
Front-end: credentialing, registration, eligibility, benefits, referrals, prior authorization, patient financial clearance. Anything wrong here becomes a denial 30 days later.
Middle: charge capture, coding, charge entry, claim creation, scrubbing, submission. This is where clinical work becomes a claim.
Back-end: payer adjudication, payment posting, denials, appeals, AR follow-up, secondary billing, patient statements, underpayment recovery, credit balances, reporting. This is where the money actually lands, or doesn't.
The three silent leaks in most practices
- Eligibility drift. A patient's coverage changed and no one checked before the visit. The claim denies for termed coverage, staff calls the patient a month later, and half those dollars quietly convert to bad debt.
- Denials that die in a queue. Most denials are workable. Most practices work a fraction of them because there is no ownership per denial reason. What isn't reworked in the timely-filing window is permanently lost.
- Payer underpayment. Payers routinely pay under contracted rates. Without an ERA-vs-contract check on every payment, 2-5% of net revenue leaks month after month with no one noticing.
- AR aging without owners. Claims sitting in the 90+ bucket compound. Every 30 days the recovery rate drops. Without a bucket-owner discipline, old AR becomes write-offs.
What good looks like: clean claim rate above 96%, days in AR under 35, denial rate under 8%, net collection rate above 95%. The whole page below is how we get you there.
Built for owners protecting the business, and admins running it day to day.
RCM lives across two floors. The owner watches revenue, margin, and risk. The admin watches queues, portals, and month-close. We report to both, in the language each needs.
More of what you earn, actually collected. Margin protected. Reporting you can act on.
- Net collections up, not just gross. We manage the whole cycle so contractual leakage, denial write-offs, and patient bad debt shrink together.
- Predictable cash flow. Days in AR come down and stay down. You stop planning payroll around a payer's mood.
- Payer accountability. Underpayments caught and recovered. Contract renewals negotiated with real data instead of gut feel.
- Compliance risk contained. HIPAA, coding, timely-filing, and payer-policy adherence documented, so audits are a formality.
- Hiring pain gone. No billing team to recruit, train, cover for, or replace. One accountable vendor. One SLA. One monthly report.
- You get your time back. Fewer "why hasn't this paid" pings, more time with patients and the growth agenda.
Queues that get worked. Denials that get answered. Month-close that lands on time.
- Eligibility done before the visit. 48-hour prior check on every appointment, with the front desk flagged on any change. Denials for termed coverage disappear.
- Denial ownership, not denial drift. Every denial routed by reason code, worked to closure inside the timely-filing window, tracked to root cause so it stops repeating.
- Payment posting daily, not "when we have time". ERAs, EFTs, and patient payments posted every business day so AR is always current and month-close isn't a scramble.
- AR worked by bucket, by owner. 0-30, 31-60, 61-90, 90+ each with an accountable owner and dollar-based prioritization. Old AR stops compounding.
- Portals and payer calls off your desk. Prior auth follow-ups, denial appeals, refund requests, credit balances, secondary billing: all handled and documented.
- A monthly report you can defend. One dashboard the owner reads, the biller understands, and the accountant reconciles.
Ten service categories. The entire revenue cycle.
From provider credentialing to financial reporting, every stage of the revenue cycle is handled by one accountable team on one workflow.
1. Credentialing & Provider Enrollment
NPI, CAQH, Medicare/Medicaid/commercial payer enrollment, contracts, EFT/ERA setup, ongoing recredentialing.
2. Patient Registration & Eligibility
Demographics, guarantor and insurance capture, real-time eligibility 48 hours before every appointment.
3. Benefits Verification
Service-specific benefits per CPT, copay / coinsurance / deductible confirmation, referral and auth flags documented with call reference.
4. Prior Authorization & Referrals
Auth requests submitted with clinical documentation, referral tracking, expiration monitoring, approval communicated back to the practice.
5. Medical Coding
ICD-10-CM, CPT, HCPCS, modifier assignment, E/M leveling, NCCI edits, LCD/NCD and payer-specific rules.
6. Medical Billing & Claim Submission
Charge capture, entry, scrubbing, CMS-1500 / UB-04 (837P / 837I) submission through clearinghouse or direct payer.
7. Payment Posting
ERA/835, EFT, checks, patient payments posted daily. CARC/RARC captured, contractual adjustments and patient responsibility recorded.
8. Denial & Appeal Management
Root-cause analysis on every denial, corrected claims per payer rules, appeals with clinical documentation and payer policy references.
9. AR & Patient Collections
Insurance AR by aging bucket, patient AR (deductibles, copays, self-pay), payment plans, statement cycle, secondary and tertiary billing.
10. Financial Reporting & Analytics
Monthly dashboard: clean claim rate, days in AR, denial rate and reasons, net collection rate, patient AR trend, plus root-cause and optimization findings.
Twenty-nine steps. Every claim. Every month.
Each step has a defined owner, a defined SLA, and a defined handoff. Nothing lives in someone's inbox waiting to be remembered.
Eight steps. Every claim. Every month.
Metrics that matter, measured and reported monthly.
Percentage accepted on first submission. Benchmark: 95%+ is excellent, 85-95% is good, under 85% needs review.
Average days from filing to payment. Benchmark: under 35 days is excellent, 35-50 acceptable, over 50 signals problems.
Percentage of receivables aging past 90 days. Red flag if above 20%. Hamdek clients typically see under 10%.
Total denials plus top five reason codes by payer. Patterns become visible within 30 days. We fix the root cause, not just resubmit.
Total collected against contractually owed. Accounts for write-offs, contractual adjustments, and patient responsibility.
Raw volume metric so you see staffing and workload. Benchmarking against your own baseline month-to-month.
Revenue cycle questions
See your full revenue cycle in one place.
A free RCM audit shows your clean claim rate, denial patterns, AR aging, net collection rate, underpayment exposure, and credentialing gaps, before you commit to anything.
Get My Free RCM Audit