Small Clinic Billing Solution
A right-sized RCM program for small practices: clean claims, fast submissions, disciplined AR, and denial prevention — with transparent dashboards.
Who It’s For
- 1–10 providers (single or multi-specialty) with limited in-house billing
- EMR + clearinghouse in place; need clean-claim flow and AR discipline
- Seasonal/coverage gaps (after-hours, weekends, PTO) hurt cash flow
- Frequent payer edits/clearinghouse rejections create rework
- Denials creeping up (eligibility, coding, modifiers, medical necessity)
Engagement Options
- Starter: claims/charge entry + clearinghouse rejections
- Plus: add AR follow-up & denial prevention
- Full-Service Billing: end-to-end with SLAs & QBRs
Module
Claims & Charge Entry
- Eligibility/benefits verification (real-time where supported)
- Charge capture/entry with coding validations & payer edits
- Clearinghouse monitoring; rejection rework within 24–48h
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Accounts Receivable
- Worklists by 30/60/90+ with payer-specific tactics
- Underpayment/zero-pay detection & resubmissions
- Patient balance outreach options
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Denial Management
- Root-cause analytics; appeal packages by payer/policy
- Preventive feedback loops to coding/front desk
- Monthly Pareto to drive fix-once changes
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Credentialing & Enrollment
- New provider enrollment & revalidation tracking
- CAQH upkeep and payer forms management
- Roster maintenance and change notices
ExploreOnboarding & Pilot
- Snapshot: top denials, AR buckets, payer mix, edits profile
- Access & BAA: least-privilege users; audit trails enabled
- Pilot (2–4 weeks): clean-claim & TAT thresholds with rollback
- Steady state: WBR/MBR cadence, dashboard & evidence tiles
- Scale/exit: knowledge capture; clear hand-off artifacts
KPIs We Track
- Clean Claim Rate (first-pass acceptance)
- Submission TAT (charge entry → payer submit)
- Clearinghouse Rejection Rate & rework TAT
- Denial Rate & Overturn % (by class/payer)
- Days in AR (DSO) and Net Collection %
Package
Starter
Claims & charge entry + clearinghouse rejections; clean-claim focus.
ExplorePackage
Plus
Add AR follow-up and denial prevention; monthly Pareto and feedback.
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Full-Service Billing
End-to-end with SLAs, QA, dashboards, and QBR governance.
ExploreKeep cash flowing. Claims clean. Denials down.
We’ll propose a clinic-sized pilot with targets for clean-claim rate, rework TAT, and AR improvement.
