One accountable team from the first scheduling call to the final payment, working inside your existing EHR. You see every claim's stage and every KPI in one place.
Quick answer
End-to-end revenue cycle management services handle every financial step of a visit: scheduling, eligibility, prior authorization, coding support, claim scrubbing and submission, payment posting, denials, A/R follow-up and reporting. One accountable team owns the whole chain, so errors are fixed where they start instead of passed between vendors.
Revenue leaks where one person or vendor passes work to another and nobody owns the result. The front desk enters a member ID, a biller sends the claim, a different team works the denial. A small error at the first step shows up weeks later as a rejected claim, and by then nobody remembers where it began.
The scale of denials is well documented. In Premier's survey published in February 2025, hospitals and health systems reported an average initial denial rate of about 15% on their 2023 claims, and about 70% of denials were eventually overturned and paid. That money was owed. It took extra rounds of work to collect.
KFF's analysis of 2024 HealthCare.gov marketplace data, published in March 2026, found that insurers denied 19% of in-network claims, with rates from 3% to 36% by insurer, and that fewer than 1% of denied claims were appealed. Among in-network denial reasons, 25% were administrative and 9% were a missing prior authorization or referral. Both are front-end problems.
We found no source that puts a single dollar figure on revenue lost to handoffs alone, so we do not invent one. What the data does show is that many denials are preventable at registration, eligibility and authorization, and that most denied claims are never appealed. End-to-end RCM puts one accountable team across those steps.
Find out which handoff costs you most
Our free practice audit reviews a sample of your claims, denials and A/R aging and shows which stage loses the most revenue. Pricing is quoted after the audit.
End-to-end revenue cycle management services cover every financial step of a patient visit, from the first scheduling call to a zero balance. In a full-service medical billing and RCM arrangement, one team owns the front end, the mid-cycle and the back end, and reports on all of it.
This page describes the service. For the full service overview, see our main revenue cycle management services page; for the software side, see our practice management system.
We start with a free audit, then take over the cycle in stages inside your existing EHR. You keep your system, your payer contracts and your data.
We review a sample of recent claims, denials, remittances and A/R aging, plus how registration and eligibility work today. You get a written summary of where revenue slips and what to fix first. Pricing is quoted after the audit.
We put a Business Associate Agreement in place before accessing patient data. Each team member then gets a personal login and a role limited to what the job needs.
We document your payer mix, your fee schedules and which stages you want us to run. The portal applies specialty-aware billing logic per claim, with 35 specialties grouped into shared billing-pattern archetypes.
Our team works inside your existing EHR (for example PrognoCIS, eClinicalWorks or athenahealth), on your practice's time zone, onshore or offshore.
Claims move through a tracked pipeline. Automation rules flag a claim for review, hold or advance a stage, or assign an owner, so every exception has a name next to it.
You get weekly KPI reporting and a review of denial reasons, underpayments and aging. Each recurring problem gets an owner and an upstream fix.
We build our billing pipeline around how claims actually move through a practice: registration, charge entry, submission, payment and follow-up.
Track days in A/R, net collection rate, denial rate, clean claim rate and A/R aging. Use published definitions so each number means the same thing every month.
HFMA's MAP Keys (2023 edition) state that one set of keys applies to hospitals and systems, ambulatory providers and physician organizations. MGMA's DataDive definitions (2025) are built for medical groups. We say which standard each number follows.
| KPI | What it tells you | Formula (as published) | Source |
|---|---|---|---|
| Days in A/R | How many days of charges sit unpaid | Total A/R ÷ (adjusted FFS charges × 1/365) | MGMA data definitions |
| Net days in A/R | The same idea on a net revenue basis | Net A/R ÷ average daily net patient service revenue | HFMA MAP Keys, FM-1 |
| Net collection rate | Share of adjusted charges collected | Net FFS revenue × 100 ÷ adjusted FFS charges | MGMA data definitions |
| Denial rate | How often claims come back denied | Claims denied ÷ claims remitted (actionable denials) | HFMA MAP Keys, AR-5 |
| Clean claim rate | Claims passing edits with no manual touch | Claims passing edits with no manual intervention ÷ claims accepted for billing | HFMA MAP Keys, CL-1 |
| Aged A/R | How much A/R is old and at risk | Billed A/R in each aging bucket (0–30 to over 120 days) ÷ total billed A/R | HFMA MAP Keys, AR-1 |
Sources: HFMA MAP Keys, 2023 edition; MGMA DataDive definitions glossary, 2025. FFS = fee-for-service. Neither source sets a universal target value.
For a longer walkthrough, read our guide to revenue cycle KPIs.
Size the gap before the audit
Enter your monthly claim volume and collections in our revenue calculator for a starting number to bring to the audit.
The stages are the same in every specialty, but where claims break is not. Procedure-heavy specialties lose revenue at authorization and modifiers; visit-based specialties lose it at eligibility and documentation. Our portal applies specialty-aware logic per claim, so a multi-specialty group is not forced into one rule set.
| Specialty group | Front end | Mid-cycle | Back end |
|---|---|---|---|
| Pain management and neurology | Prior authorization for procedures and repeat injections; coverage rules checked before scheduling | Procedure codes, modifiers and units matched to the note; diagnosis linked to the service | Denials by reason and payer; short payments checked against expected amounts |
| Cardiology | Authorization for imaging and procedures, where the plan requires it | Professional, technical or global billing depends on who owns the equipment and who reads | Repeat-study and documentation denials traced to the ordering step |
| Orthopedics and general surgery | Surgical authorization and the assistant or facility rules for each case | Global-period and modifier rules checked on follow-up visits | Claims split across surgeon, assistant and facility need clear owners |
| Radiology and pathology | Order and authorization verified before the study | Professional and technical components kept separate; ordering provider details complete | Rejections for missing order or referring-provider data worked at the source |
| Behavioral health | Benefit and visit-limit checks by plan before each series of sessions | Session length and service type matched to the code billed | Authorization expiry dates tracked so renewals do not lapse |
| Dermatology and ophthalmology | Medical vs cosmetic or routine coverage confirmed up front | Medical necessity documented for each procedure; diagnosis links checked | Denials split by medical vs non-covered reason |
| Family practice and internal medicine | Eligibility on every visit; high patient volume | Visit level and preventive services coded to the note | Volume of small balances worked by value and age |
| Pediatrics and urgent care | Guarantor and coverage checks at registration; walk-ins need same-day checks | Vaccine, visit and procedure charges all reach the claim | Patient balances and plan changes followed up quickly |
Operational patterns by specialty, not statistics. Payer rules vary by plan; confirm each against the payer's own policy. Details on each specialty page.
Each name above links to that specialty's page, with the codes, payer rules and sources behind it. For the full list of 35 specialties, see our specialty RCM hub.
Choose the model that can cover every stage, every day. In-house gives the most control, outsourced RCM for medical practices adds depth and coverage, and a hybrid splits tasks between your office and a partner.
| Factor | In-house team | Outsourced RCM | Hybrid model |
|---|---|---|---|
| Day-to-day control | Highest | Shared, set by scope and reporting | Split by task |
| Coverage when staff are out | Gaps unless cross-trained | Vendor covers absences | Partner covers its stages |
| Depth in coding and appeals | Limited to who you can hire | Usually broader, across many payers | Partner fills the gaps |
| Visibility | Your own reports | Vendor reporting; ask for claim-level access | Needs one shared dashboard |
| Cost structure | Salaries, benefits, software, training | Contract fee (ours is quoted after a free audit) | A mix of both |
| Usually suits | Larger groups with stable billing staff | Practices short on staff or facing rising denials | Practices keeping the front desk local |
Decision guide based on common operating models; no sourced statistics.
A common hybrid: keep your front desk, add virtual medical assistants for eligibility and prior authorizations, and hand everything after the visit to an RCM team. Ask: can your team work every denial before its appeal deadline, and who covers billing when your biller is out? More in our article on how front desk staff affect the revenue cycle.
Not sure which model fits?
Talk it through with our RCM team. If keeping billing in-house makes more sense for your practice, we will say so.
Revenue cycle results depend on what happens before and around billing. We run RCM as one of four connected services.
Marketing decides which patients and plans reach your schedule. We aim local SEO, Google Ads and reputation work at the services you want to grow.
Many avoidable denials start at registration. Our virtual medical assistants handle scheduling, eligibility checks, prior authorizations and intake.
Coding support, scrubbing, denial management and A/R follow-up, run by one accountable team.
Our portal shows where every claim stands and who owns the next step, for practices and billing companies.
Any RCM vendor that handles your patient data is generally a HIPAA business associate and needs a Business Associate Agreement. Beyond that, ask how the vendor limits access, logs activity, tracks filing deadlines and returns your data.
HHS guidance lists billing and practice management among business associate functions. It says a covered entity may disclose patient data to a business associate only with satisfactory assurances in a written agreement, and that business associates are directly liable for certain HIPAA provisions. HHS's minimum necessary guidance asks covered entities to identify which workforce roles need which patient information, and the Security Rule's 45 CFR 164.312 sets access-control and audit-control safeguards.
Our own setup: role-based access, audit logging, encrypted HTTPS connections, and a Business Associate Agreement in place before we access patient data. For your side, use our HIPAA compliance checklist.
We would rather tell you now than after you sign. Here is where we fit and where we do not.
A good fit if you are
Probably not a fit if you are
What we would do first if we were running your practice's revenue cycle tomorrow.
We check registration, eligibility and authorization first. In KFF's 2024 marketplace data, administrative reasons and missing authorization or referral made up about a third of in-network denial reasons.
A handoff without an owner is where claims stall. We write each stage, its owner and its exit condition down before we add automation.
We sort open claims by the nearest filing or appeal deadline and by value, so recoverable money is worked before it expires.
Underpayments cannot be found without an expected amount. Share your fee schedules, and we use them as the baseline for underpayment checks.
We follow HFMA and MGMA formulas and say which one each number uses, so trends stay honest month to month.
We tag each denial with the stage where it started and review the top reasons weekly, so the fix lands where the error began.
End-to-end revenue cycle management means one team handles every financial step of a patient visit: scheduling, eligibility and prior authorization, charge capture and coding support, claim scrubbing and submission, payment posting, denials, A/R follow-up and reporting. The point is a single owner for the whole chain, so errors are fixed where they start instead of passed between vendors.
Billing-only services usually start when the claim is ready and end when it is sent or paid. A full-service arrangement also covers the front end, such as eligibility and prior authorization, and the back end, such as denial root causes and reporting. Ask any vendor for a written list of the stages it runs and the stages left to your staff.
It depends on whether your team can cover every stage on every day, including absences, and work each denial before its deadline. Many small practices keep the front desk and outsource everything after the visit. We say so if in-house suits you better. Our free audit shows where your current process loses time.
No. Our team works inside your existing EHR, for example PrognoCIS, eClinicalWorks or athenahealth, using the access you grant. Our portal sits alongside it for claim-stage tracking, underpayment checks and reporting. We do not claim official partnerships with EHR vendors.
Pricing depends on claim volume, specialty, payer mix and how many stages you hand over. Billing companies price in different ways, so compare what each quote covers. We quote after a free practice audit so the price reflects your actual workload. Ask any vendor what is included, such as old A/R, patient statements and reporting.
Start with days in A/R, net collection rate, denial rate, clean claim rate and the share of A/R in the oldest aging buckets. Use a published definition, such as MGMA's or HFMA's, so numbers stay comparable month to month. Watch trends and the reasons behind them rather than a single month. We report these weekly.
Tell us about your practice. We will contact you using the details you give.
Pricing is quoted after the audit, based on your volume and the services you choose. Prefer to talk? Call +1 (302) 556-2288.
Tell us about your practice
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