Revenue Cycle Management Services Software Solutions

End-to-End Billing, Coding, Credentialing, Compliance, & More…

FREE Coding Review with Benchmarking and Practice Performance Analysis with Every Demo

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Over 40 Years of Industry Leading RCM

There is no “one size fits all” in medical billing.

Each organization has different needs from stand alone software to best in class end-to-end RCM solutions supported by award-winning billing cycle experts with decades of hands-on experience.

Free Consultation

How It Works

The first step is a simple 15 minute meeting with one of our specialists who will ask a few questions, answer any answers you have, and provide pricing for any services you are interested in.

It’s fast, pressure-free, and designed to provide the range of solutions that best align with your practice and provider needs, existing process, medical specialty, size, and current efficiency levels.

By the end of the brief conversation you will know how your current numbers compare to what you should be making.

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The Claimocity Clearinghouse

Number of Practices: 1851
Number of Doctors: 17,507
Claims Submitted Per Annum: 42 Million
Value of Claims Per Annum: 10 Billion
Value of Cash Posted: 3.5 Billion
Number of Denials Handled: 1.5 Million
Number of Appeals Sent: 270,000
Number of Calls Made: 4 Million
Providers Credentialed: 150,000

A/R Metrics that Matter

95% Realization Rate at 45 Days

99.3% Net Collection Rate

99.4% Standard Clean Claim Rate

Under 3.7% A/R Over 120 Days

Under 4.2% Claim Denial Rate

95.8% First Pass Claim Yield


What Do These Metrics Mean?

Benchmarking the revenue cycle management metrics of a clearinghouse is a very effective tool for evaluating the quality of the RCM service yet a clear understanding of the terms combined with qualifications of success criteria are essential for comparing one RCM company against another and making the best choice.

Clean Claim Rate Can Be Misleading

The term clean claim rate refers to a clearinghouse’s degree of consistent success in getting claims processed but nearly every clearinghouse worth it’s weight has a rate that exceeds 90% and the metric has been relatively outdated by increasingly complex payer rules.

The bottom line is that using clean claim rate as a reliable RCM benchmark for evaluating a revenue cycle service company is a flawed approach primarily because of its marginal impact on cash flow.

First Pass Claim Yield is a Top Metric

This represents the percentage of claims that are paid on their first submission, putting the emphasis on denial prevention by requiring a higher allocation of time and resources to the pre-claim submission process, limiting the number of incorrect claims which is turn reduces time spent working on denials while increasing cash flow.

The bottom line is that focusing on first pass yield creates more work on the front end yet driving measurably higher RCM efficiency.

KPI Evaluation: Net Collection Ratio

The net collection rate is the adjusted rate that measures the effectiveness in collecting reimbursement payouts.

The bottom line is that like first pass yield, the net collection rate is an indicator of the relative success or failure of the revenue cycle service by evaluating what percentage of everything owed is being collected.

Evaluating Your A/R Realization Rate

A high quality accounts receivable process is critical to a providers success and possibly the most critical KPI for evaluating the success of an RCM company. The magnitude of accounts definitely matters but the age of those accounts creates some of the most important RCM metrics for evaluative purposes.

The bottom line is that evaluating the percentages at more than 30, 60, 90, and 120 days gives crucial insight into where in the AR process the majority of claims are being paid and what degree of success is occurring at each stage for the more difficult .

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Mobile Software and RCM Services

Mobile medical billing and coding software solutions with end-to-end RCM services for practices with physicians who see patients exclusively in acute care, LTAC, IRF, SNF, or other sub-acute step-down facilities.

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Hybrid Mobile + Office Solutions

Award-winning RCM services and modern billing software solutions for medical practices with physicians who see patients both in their office and in hospitals and other acute care or step down facility environments.

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Medical Facility RCM

Facility-based RCM software and services for surgery centers, urgent cares, emergency departments, SNFs, senior living facilities, and other acute care or step down organization environments.

Best Revenue Cycle Management Software
  • Accelerated Charge Capture
  • Modern PM App and Desktop Portal
  • Hybrid Custom Solutions
  • Seamlessly Integrated EHR/EMR
  • Full-Service Contracting & Credentialing
  • Patient and Facility Scheduling
  • Compensation Management
  • Advanced Reporting and Analytics
  • Comprehensive Patient Engagement
  • And so much more…

Specialty Focus

From practices with hospitalists and clinicians with encounters in acute care and step down facilities to office-based medical practices, we have solutions for every specialty.

Revenue Efficiency

Even a 1-2% improvement in revenue efficiency can have a 10-20% impact on bottom line financial growth. By improving efficiency we maximize your financial potential.

Custom Solutions

Cookie cutter software packages leave money on the table. Every practice and specialty requires a specific approach that we design to fit your needs and growth potential.

Integrated Tech

Our full-service end-to-end RCM services are designed to work with any combination of mobile charge capture, scheduling, EMR/EHR, and practice management tools.

Faster Growth

From a comprehensive initial A/R audit by our coding and billing team to our full RCM and PM processes, Claimocity drives consistent financial growth from month one.

Streamlined Billing for Faster Reimbursements

The Claimocity end-to-end revenue solutions utilize a blend of AI-enhanced smart technology and robust RCM billing teams with decades of experience to achieve higher and faster reimbursements while maximizing your revenue cycle operations with award winning results.

Our software and services reduce administrative burdens and help automate and streamline claims management, payment processing, coding, contracting, credentialing, and compliance to ensure that the clinicians, front office, practice manager, and billing team are always on the same page.

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Claimocity Smart Workflow

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Smart Custom Solutions

Long term success starts with the right initial processes. Our billing, coding, operations, intake, and software teams assist in the smart setup to proactively define the best platform combination for the client while identifying and resolving any root issues, completing a thorough A/R review, and designing a custom RCM solution platform to meet your specific specialty, practice size, and needs.

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Easy Implementation

Claimocity is designed to quickly and seamlessly integrate into any existing practice, system, or frameworks, supporting physicians, managers, and office staff in every critical role. The software is user friendly to streamline the workflow and focused on simplification and automation in order to improve time and revenue efficiency while making the software as intuitive and easy to use as possible.

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Time & Revenue Efficiency

Claimocity offers award-winning software options including native iOS and Android applications, mobile and desktop-based practice management suites, accelerated mobile charge capture, integrated EHR, contracting, credentialing, scheduling, and coding efficiency tools that reduce administrative burdens, streamline billing workflows, and save high-value time for staff and physicians.

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Award-Winning Expertise

Decades of highly specialized collective experience, cutting edge next gen AI-enhanced technology, implementable best practices, smart workflow processes, actionable insights, and the hands-on approach of our highly experienced team of coders, billers, support staff, techs, and medical specialists are just part of the reason that physicians, admin staff, practice managers, and owners love using Claimocity software.

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Data-Driven Decisions

KPIs, actionable analytics, and real-world data on both the provider and practice level enables a higher level of insight and data gathering for more effective decision making. Claimocity enables greater transparency in the billing and coding process while generating a stronger understanding of productivity and performance including compensation management tools and daily financial updates for physicians and practice managers.

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AI-Enhanced Advantages

From our proprietary rules engine and custom personalized patient and facility management filters to practice and provider-level AI-enhanced pattern analysis and machine learning systems, our technological advantage, super computing enhancements, big data processing infrastructure, and efficiency-driven statistical analyses create a deeper level of business intelligence for higher efficiency and productivity models.

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Claimocity Hospitalist Reporting Features

Key Advantages

Award-winning benchmarks, metrics, and revenue efficiency processes driven by end-to-end technological and team-driven approaches that systematically outclass stand alone or in-house billing.

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Custom Solutions

Contract industry-leading revenue growth and claims processing services independently or use billing in conjunction with EHR/EMR, scheduling, and advanced practice management software.

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Financial Growth

From an initial A/R audit to triage live claims caught in process stuck points to AI-enhanced comprehensive billing services designed to maximize existing revenue streams and open up financial opportunities for growth.

“Our executive team approved participation in a voluntary two year time and revenue study in order to evaluate the quantitative and qualitative value compared to the numbers we were generating with the prior software in order to justify the switch. Within 24 months we had a 41.6% net revenue rate increase as well as an average of 38.8 hour savings per month per physician across our practice, which was a remarkable result.”

dr chacinF. Cacin M.D., Founder and CEO

What is Revenue Cycle Management Software?

Revenue Cycle Management (RCM) software captures, submits, tracks, and manages the claims-side practice financials for payer-based services in order to maximize a healthcare organization’s revenue cycle efficiency and improve the billing, coding, and accounts receivable processes.

A strong, healthy RCM optimizes existing revenue streams to drive higher efficiency and help practices and physicians collect every payable dollar they have earned in the fastest manner possible with the least amount of energy expenditure while providing a strong foundation for financial optimization and organizational growth.

Best Charge Capture Revenue Cycle

The revenue cycle in value-based reimbursement is arguably the most critical piece of a healthcare practice’s viability in both the short and long term, directly and indirectly enabling the staff to work more efficiently, the managers and owners to effectively make the best decisions, and the physicians to provide the highest level of quality care.

Anything less than absolutely top tier RCM output creates significant risks for a medical practice by generating gray areas, confusion, unresolved inefficiencies, revenue gaps, and bottom line losses that snowball into stagnated growth and organizational stress levels resulting in lower morale, further inefficiencies, and a reduction in the ability of the providers to focus solely on the delivery of quality care.

There is no single better investment for a medical practice than its revenue cycle management process and efficiency.

Timing is Everything in Billing

Though some argue it begins at the setting of a patient appointment, the measurable revenue cycle begins at the point of care (when the claim timer begins) or more specifically at the point of charge capture (when the RCM experts get their hands on it) and ends with the successful collection or unsuccessful conclusion of the claim.

Every claim or charge has an insurance company time limit or expiration date after which no amount of troubleshooting or adjusting can change the outcome. Some will move smoothly through the process (clean claims) but many will requiring finessing, adjusting, fixing, finding, troubleshooting, or forcing through to the payout point within the allowable time frame.

Ever changing healthcare regulations and reimbursement models, compliance issues, audits, bureaucratic hurdles and red tape, human errors, time constraints, technology limitations, filing mistakes, delays, limited resources, software issues, and even global pandemics are all RCM challenges that can have a dramatic impact on reimbursement financials.

But at the end of the day, the biggest impacting factors that a practice or provider can control when it comes to giving their claims the best start is the charge capture and coding after the point of care. Higher coding efficiency and faster charge capture can have a significant impact on bottom line financials while driving higher time efficiency models as well.

Clinician Revenue Cycle Management Services

Claimocity Healthcare Revenue CycleAs mentioned above, a provider often has very little impact on the claim review and denial portion of the revenue process after the charge has been captured. In fact, there is so little transparency in the process that once providers submit their billing, they often have no idea what the individual results may be, seeing payments months later with no clarity on which claims were paid and which were denied.

The lack of transparency shows in a muddled mess of insurance eligibility issues, failed patient payments, A/R process stuck points resulting in good claims going unpaid, unmet contract rates, questionable and erroneous denials, lost and missing claims, and other gray areas results in a process highly advantageous to the insurance companies, which results in distinct disadvantages for physicians and medical practices.

Claimocity RCM was designed to even the playing field and take back all the revenue that insurance companies collect when doctors leave it on the table.

Our billing team and system creates unrivaled transparency, lowering the veil between the providers and the insurance bureaucracy payout system so that doctors and practice managers can track claims from the point of care (or charge capture) to the conclusion while generating cleaner, clearer, and better data to make more effective decisions with.

Patient Responsibility and Collections

Patient responsibility is a significant and often uncontrollable issues in the RCM process. Not only is patient responsibility for healthcare costs rising but unpaid medical debt is a massive economic issue with bottom line impacts. If a patient doesn’t pay their portion, an encounter value goes down, and when this is combined with an insurance payout that comes in less than the contracted rate, promising financial encounters can consistently become low value payouts.

One of the ways to combat this are patient pre-registration and front-loading the payment process.

Patient pre-registration is helpful in gathering and utilizing advanced medical information and demographics (including the insurance information necessary to evaluate coverage, additional insurance, maximum allowable visits, patient financial responsibility, and the upfront information necessary to evaluate claim denials) which enables a good RCM company to better estimate a patient’s responsibility and likelihood to pay, which can impact how an encounter is coded and processed to maximize revenue while maintaining code integrity and efficiency.

Medical Revenue Cycle Management

Medical revenue cycle management is more art form than science, requiring a complex blend of experience and efficiency to know how to structure, troubleshoot, steamroll, and finesse different claims through the payout process in order to generate the highest clean claim and net collection rates and lowest denial rates while tracking claims and financials in a manner conducive to actionable reporting and physician performance analytics.

In addition to being experts in the art of billing and collections, a skill set that comes from decades of specialized experience, Claimocity has a huge staff of coding and billing specialists with the sheer robust manpower to make the dozens or even hundreds of calls necessary to troubleshoot and push through a single stuck claim. Our teams work in shifts around the clock to provide coding and billing support at any hour, constantly working the accounts receivable process from multiple angles.

Charge Capture Revenue Cycle

Medical RCM ServicesOne of the most relevant forms of modern RCM is the charge capture revenue cycle, which is the direct result of the billing evolution from traditional paper billing methods to electronic and mobile charge capture software methods.

The evolution of the phone to a smart device capable of processing complex billing software on the go is changing the revenue cycle game.

Mobile charge capture enables a quicker start to the RCM process by capturing the claim much closer to the point of contact, giving the billing company or service more time to process, manage, troubleshoot, and collect before the expiry date set by the insurance company.

Not to mention the increased revenue efficiency that comes from the mobile charge capture ability to reduce lost or missing claims, catch human errors associated with paper billing, and convenience of being able to process billing from a pocket smartphone without all the burdensome paperwork and unnecessary administrative burdens.

Factors that Impact RCM

Healthcare workers and billers usually operate on limited resources and have very little control over the claims process but there are some areas that can be emphasized by the organization in order to generate higher revenue efficiency models. A few of these internal factors include practice and provider productivity, patient volumes, patient pre-registration, and collecting fees for services are focal areas that providers can improve to drive strong RCM results.

Other factors that often impact revenue management are fragmented administrative workflows and information sharing is critical for streamlined billing. Bottlenecks and gray areas in the revenue cycle can come from poor communication processes, and improving front end and back end communication on coverage eligibility during the patient intake process can facilitate a useful understanding of payer coordination, historical reimbursement averages, and likely payment collection amounts.

Tracking claims is a highly underrated portion of the healthcare revenue cycle management process, though often while the data may be collected, very few software options actually present the collected information in a user-friendly reporting format that a physician or practice manager can use to evaluate actionable insights and make more effective data-driven decisions going forward.

Neglecting the claim tracking portion not only increases the likelihood of accounts receivable bottlenecks and stuck points, but ignores information that can be used to determine where revenue flow problems originate to facilitate updating SOPs and best practices regarding specific procedures or codes to help increase understanding and awareness to reduce recurrences.

Healthcare Revenue Cycle Management

Claimocity focuses heavily on designing software solutions for hospitalists and clinicians who perform encounters in acute care or sub-acute step-down facilities. Our healthcare revenue cycle management services are the backbone of the company and are available as stand alone billing services or in combination with integrated EHR, practice management, scheduling, compensation management, mobile charge capture, or any other available smart software tools your practice needs.

Additionally, the Claimocity healthcare RCM is built as a perfect solution for office-based practices like urgent cares, emergency departments, surgery centers, clinics, and other specialty based healthcare facilities.