What our revenue cycle management services include
Fastora provides revenue cycle management services for physician practices and outpatient providers, covering every step from the first scheduling call to the final patient balance. Our revenue cycle management solutions run as one connected workflow, handled by certified medical billing and coding professionals rather than a chain of separate vendors. It is healthcare revenue cycle management built for professional, office-based billing.
Think of it as healthcare reimbursement services with a single owner. The team that verifies coverage before the visit also follows the claim through coding, submission, payment posting and appeal, so a small error at the front desk is caught before it turns into a write-off months later.
We work inside the EHR/PM system you already use. There are no hidden setup fees and no software to install, and every practice has a dedicated account contact. If you want the background first, our guide to the steps of the revenue cycle explains each stage in plain language.
Front-end: scheduling, eligibility and authorizations
End-to-end revenue cycle management starts before the patient arrives. Most lost revenue begins at the front end and only becomes visible weeks later as a denial, so this is where our Virtual Assistant phase does its work: scheduling, registration, insurance checks and co-pays collected upfront.
Eligibility verification
Plan status, network status, deductibles, co-insurance, visit limits and secondary coverage are confirmed before the visit through eligibility and benefits verification. Where the payer supports it, checks use the standard HIPAA 270/271 eligibility inquiry and response; otherwise we use payer portals or a call. Coverage changes, such as a new plan year or a lost Medicaid eligibility, are flagged to the front desk before check-in.
Prior authorization
Services that need payer approval go through our prior authorization team before the appointment. We track the approved units, dates and service codes, because an authorization that expires or runs out of visits causes the same denial as one that was never requested.
Registration errors are the other front-end risk: a misspelled name, an old member ID or the wrong subscriber turns into a rejection. Clean demographics and a current insurance card on file are simple checks that support cleaner claims.
Mid-cycle: charge capture and coding
In the Scriber phase, visit documentation is recorded in the EHR in real time, so charges reflect what was actually done. Mid-cycle work is where revenue integrity is won or lost: every billed service should be documented, and every documented service should be billed at the right level.
Charge entry
Charges are entered from the signed note and the encounter, then reconciled against the schedule so a visit without a charge is noticed the same week. Late or missing charges are one of the quietest sources of lost revenue, because nothing ever comes back from the payer to point them out.
Coding
Certified coders assign CPT, ICD-10-CM and HCPCS codes and review E/M levels and modifiers through our medical coding service. When the note does not support a code, the coder sends the provider a specific question rather than guessing, and recurring documentation gaps are raised in the monthly review.
Back-end: claims, payments, denials and AR
Claims pass Advanced Pre-Submission Claim Review before they go out, and our claims management team tracks each one through the clearinghouse and payer. Physician practices submit professional claims as the 837P transaction or on the CMS-1500 form, and clearinghouse rejections are corrected and resubmitted the same way.
Payment posting
Remittances, usually the 835 electronic remittance advice, are reconciled line by line through payment posting. This is where underpayments, partial denials and credit balances are caught, by comparing each payment with the expected amount instead of posting the difference as a routine adjustment.
Denials
Denials are worked by reason code under denial management and appeals. Each one is corrected and resubmitted or appealed, and grouped by cause so the step that produced it, such as registration, authorization or coding, can be fixed.
A/R
Unpaid claims are followed up by payer and aging bucket through accounts receivable management, starting with balances closest to timely filing limits. Remaining patient balances move to patient billing and collections, with clear statements and payment plan options set by your policy.
Analytics and KPIs we report
You see the same numbers we work from. Transparent dashboards and monthly performance reporting cover claim volume, collections, denials by reason and payer, and AR by aging bucket, and a monthly review call walks through what changed and what we are doing about it.
| Measure | What it shows |
|---|---|
| Clean claim rate | Whether front-end and coding work is holding up before submission |
| First-pass rate | How many claims are paid without rework or appeal |
| Denial rate by reason and payer | Which step in the cycle needs fixing |
| Days in AR | How long, on average, money takes to arrive after service |
| AR over 90 days | Balances at risk of filing limits or write-off |
| Net collection rate | Payments against what you were contractually owed |
Custom reports are available on request. Report layouts, dashboard views and the full list of measures are described on our billing analytics and reporting page, and our article on medical billing KPIs explains how each one is calculated.
RCM for specialty practices
Our work is built around ambulatory revenue cycle management: single-specialty clinics, multi-provider groups, therapy practices and independent outpatient providers. We focus on professional, office-based billing rather than inpatient or facility claims.
Outpatient revenue cycle management looks different by specialty. Behavioral health practices deal with time-based psychotherapy codes and carve-out plans, therapy clinics track timed units, plan-of-care certifications and visit limits, and procedural specialties depend on modifiers and global periods. See how we handle behavioral health practices, physical therapy clinics and the other specialties we serve.
Revenue cycle management for physician practices
Physician revenue cycle management depends heavily on E/M level selection, modifier use and each payer's specialty policies. RCM for physician practices also has to fit a lean staff: the same few people may handle check-in, phones, authorizations and billing, so follow-up is the first task to slip in a busy week. Our role is to take the repetitive, deadline-driven work off that team and keep it moving every business day.
Revenue cycle management for small practices
In small practices one person often holds all of the payer knowledge, so a vacation or resignation can stop follow-up entirely. A team-based model keeps work moving and adds reporting a small office rarely has time to build. Our page on billing for small practices covers solo providers and small groups.
RCM outsourcing: what you hand off and what you keep
Revenue cycle management outsourcing does not mean giving up control, and RCM services for physician practices should be scoped around what you want to keep. You hand off the daily billing workload and keep the clinical and business decisions that belong to the practice. Deciding to outsource your revenue cycle is a decision about who does the work, not who owns the outcome.
| You hand off | You keep |
|---|---|
| Eligibility checks and authorization requests | Scheduling decisions and patient relationships |
| Coding, claim scrubbing and submission | Clinical documentation and sign-off on charts |
| Payment posting, denial work and AR follow-up | Payer contracts and approval of write-offs |
| Patient statements and balance follow-up | Financial policies, such as payment plan terms |
Revenue cycle outsourcing works best when the practice sets the policies and the billing team carries them out consistently. If you are weighing a full handoff against keeping staff in-house, our overview of outsourced billing compares the two approaches.
Revenue cycle optimization without a full handoff
Some practices want advice rather than a team. Revenue cycle management consulting usually starts with an assessment of denials, AR and payer payments, followed by specific fixes for the in-house staff to make. Our free claims audit is a practical first step for either path, because it shows where the cycle loses time or revenue before you decide anything.
Technology-supported workflows and RCM automation
RCM automation is useful when it removes repetitive steps and leaves judgment to people. We use the tools already available in your practice management system and clearinghouse rather than adding software.
- Electronic eligibility checks using the 270/271 transactions, where the payer supports them.
- Claim edits in the PM system and clearinghouse that flag missing fields, invalid code pairs and payer formatting issues before submission.
- ERA auto-posting of 835 remittances where your PM system supports it, with manual posting for paper EOBs.
- Work queues that sort denials, rejections and unpaid claims by payer, age and reason, so nothing depends on someone remembering it.
These tools handle routine volume; our billing staff review every exception. A rejected claim, an unusual adjustment or a payment that does not match the expected amount goes to a person, not back into the queue.
How to compare an RCM company
When comparing RCM companies in the USA, look past the headline rate to how the work is done. Ask who handles your account day to day, whether coders are certified, how denials are traced to root cause and what the monthly report shows.
- Is the scope written down, including what happens to existing AR?
- Will the team work inside your system, or require new software?
- Who signs the Business Associate Agreement, and are subcontractors involved?
- How are refunds, credit balances and write-offs approved?
- How are your data and reports returned if the agreement ends?
Fastora's answers are simple to check: every claim is handled by certified medical billing and coding professionals, workflows are aligned with HIPAA and HITECH with encryption, secure server environments, strict access controls and regular internal audits, and each practice has a dedicated account contact backed by 24/7 dedicated client support. Pricing is quoted after the free assessment; see our pricing models.
Revenue cycle management vs medical billing
Medical billing handles the claim: charge entry, submission, posting and follow-up. Revenue cycle management adds everything around the claim that decides whether it pays — scheduling and registration done right, eligibility and authorization checks before the visit, coding and documentation review, and reporting that ties it together. The difference shows up in denials: a billing team works the denial after it arrives, while an RCM team traces it to the front-desk step that caused it and fixes that step. Most practices do not need to choose forever — the question is which parts of the cycle are breaking today.
When is full RCM worth it over billing alone?
When the problems start before the claim exists: eligibility mistakes, missing authorizations, charge lag or a front desk too busy to collect. If denials keep tracing to the same upstream step, that step needs owning — not just the claim it produced.
Can we start with billing and add RCM phases later?
Yes. Many practices start with claims, denials and A/R, then add eligibility verification, authorization handling or front-desk support as volume grows. Each phase is scoped in writing, so you always know who owns what.
What is RCM in healthcare?
Healthcare revenue cycle management — RCM — is the full cycle of revenue work around a patient visit: registration, eligibility and benefits checks, authorization, coding and documentation review, charge capture, claims submission, payment posting and reconciliation, denials, A/R follow-up, and reporting. Where plain claims billing starts at charge entry, healthcare revenue cycle solutions look at the whole loop, including the front-desk and documentation steps that decide whether a claim pays on first submission. When practices search for comparisons like RCM vs billing, the question they are really asking is who owns the steps before and after the claim — and the honest answer is the parts of the cycle that keep breaking today.
RCM process steps and end-to-end services
The RCM process steps run in order: patient access (scheduling, registration, eligibility), clinical documentation and coding review, charge capture, claims submission, payment posting and reconciliation, denial management, A/R follow-up, and reporting. Our end to end RCM services — end-to-end revenue cycle services — cover that whole sequence in one engagement, with medical RCM services and end to end medical billing services scoped the same way for practices that want claims included under one roof. Each phase is documented in writing, so you always know who owns which step. See our medical billing services page for the claims side of the work.
RCM for private practices, physicians, and behavioral health
RCM for private practice is the most common engagement: a small group hands off the daily rhythm of eligibility, claims, denials, and follow-up, and keeps scheduling and the front desk in-house. Physician RCM services add specialty coding review and payer-specific rules for surgical and procedural practices. PT RCM covers session-based billing, visit limits, and unit rules for physical therapy practices. Revenue cycle management for behavioral health — the same work described as RCM services for behavioral health — handles carve-out plans, session authorizations, concurrent reviews, and telehealth rules. Our behavioral health billing page describes those workflows.
How much do RCM services cost, and what is revenue cycle consulting?
RCM services cost follows scope: claim volume, specialty complexity, payer mix, old A/R, and which phases you hand off. A percentage-of-collections model ties the fee to what is actually collected; defined projects such as A/R cleanup are priced separately. Revenue cycle consulting is a different engagement: a defined project — a billing assessment, workflow fixes, payer contract review — rather than ongoing billing. A full service RCM company should be able to do both: consult on what is broken, then run the cycle if you want it run. When you compare a healthcare RCM company or an RCM outsourcing company, ask for the scope in writing, a named account contact, and monthly reporting you can check against your own EHR. Start with a free medical billing audit to size the scope or read our medical billing outsourcing page.