Eligibility & Benefits
Real‑time checks, coverage validation, prior auth tracking, and patient responsibility estimation.
- Real‑time 270/271
- PA status & reminders
- Patient cost estimates
Zero-Balance Recovery Specialists
Elevate Your US Healthcare Revenue Cycle
From eligibility to zero-balance resolution, R2RCM orchestrates clean claims, faster cash, and sustained denial prevention—built for HIPAA-grade compliance.
Specialization in Zero-Balance Recovery
Recover hidden revenue with contract variance analytics, retro reviews, and payer escalation playbooks.
- 98%+ first‑pass acceptance
- 25–35% faster cash collections
- 30–50% denial reduction
Trusted by multi-specialty groups, ASCs, and behavioral health networks across the US.
End‑to‑End RCM Services
Modular services that connect into a single, measurable revenue cycle.
Zero‑Balance Recovery
Specialized workflows to recover hidden revenue from zero‑balance inventory with payer‑level strategies.
- Contract variance mining
- Underpayment analytics
- Retro review & appeals
Medical Coding
Accurate CPT/HCPCS/ICD‑10 with LCD/NCD edits, modifier usage and audit trails.
- Specialty coders
- Pre‑bill audits
- Compliance reviews
Charge Entry
Encounter normalization, charge scrubbing and CCI edits for cleaner claims.
- Rules‑based edits
- Batch imports
- Provider feedback
Claims Management
Clearinghouse integrations, payer‑specific edits, and rejection workqueues.
- X12 837/835
- Payer rules library
- Rejection remediation
Payment Posting
Automated ERA posting with underpayment detection and variance workflows.
- Auto‑posting with QA
- Contract variance flags
- Secondary billing triggers
Denials & Appeals
Root‑cause analytics, timely appeals, and prevention rules embedded upstream.
- CARC/RARC mapping
- Appeal templates
- Preventive edits
AR Follow‑Up
Risk‑based scoring to prioritize high‑value accounts and reduce aging.
- Workqueue automation
- Collector productivity
- Root‑cause feedback
Patient Billing
Clear statements, SMS reminders, portals and payment plans for better collections.
- Omnichannel outreach
- Self‑serve portals
- PCI‑DSS payments
RCM Analytics
Dashboards for clean claims, AR aging, denials, cash, and payer performance.
- KPI scorecards
- Benchmarking
- Export & API access
Proven RCM Workflow
Closed‑loop process with preventive edits and measurable outcomes.
- 1. Patient access: scheduling, eligibility, prior auth
- 2. Clinical documentation: coding and charge capture
- 3. Pre‑bill: scrubbing, CCI/LCD edits, compliance checks
- 4. Claims: submission, payer rules, rejection rework
- 5. Payments: ERA/EOB posting, underpayment detection
- 6. AR & Denials: appeals, follow‑up, prevention
- 7. Patient billing: statements, payments, support
- 8. Analytics: KPIs, root causes, continuous improvement
Compliance & Security
Designed for US healthcare with strict safeguards.
HIPAA
BAA, minimum necessary, audit logs, breach notification, encryption in transit and at rest.
HITECH
Risk assessments, continuous monitoring, data integrity and availability controls.
PCI‑DSS
Tokenized payments, restricted scope, annual assessments and segmentation.
SOC 2
Security, availability and confidentiality principles baked into operations.
Case Studies
Real outcomes across specialties and payer mixes.
Multi‑specialty Clinic
First‑pass acceptance improved from 91% to 98.4% in 60 days, reducing denials by 43%.
ASC Network
Days in AR dropped from 44 to 27, with automated underpayment capture raising yield by 3.1%.
Behavioral Health
Eligibility automation and payer‑specific edits cut rework by 52%, improving staff productivity.
Frequently Asked Questions
Quick answers about scope, pricing and onboarding.
Do you support my PM/EMR and clearinghouse?
Yes. We integrate with leading PM/EMRs and clearinghouses and can adapt to custom payer workflows.
How do you price services?
Flexible models: percent of collections, per‑claim, or hybrid—aligned to measurable outcomes.
What does onboarding look like?
2–4 weeks for discovery, access, rules configuration, and pilot. Full rollout typically in 6–8 weeks.
How do you handle PHI?
We sign BAAs, enforce least‑privilege access, and use encryption in transit and at rest with detailed audit trails.
Carrier
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Additional Information
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