Medical Billing Services (RCM) – Service Areas

Core RCM Functions

  • Eligibility & benefits verification
  • Prior authorization support (as applicable)
  • Charge capture & claim creation
  • Claim submission (professional + institutional)

Coding & Compliance

  • Coding support & documentation alignment (CPT/HCPCS/ICD-10 review; compliance-focused)

Payments & Reconciliation

  • Payment posting (ERA/EOB)
  • Underpayment identification & contract variance review

Denials & AR Management

  • Denial management & appeals (Availity/portal workflows, medical necessity, timely filing, recoupments)
  • AR follow-up & collections workflow

Patient & Account Handling

  • Patient statements / self-pay workflows (if you offer it)
  • Refunds, voids, corrected claims

Reporting & Performance

  • Monthly financial reporting & KPIs (AR aging, clean claim rate, denial rate, days in AR, net collection rate)

Credentialing & Enrollment

  • Credentialing support/payer enrollment coordination (if in scope)

Service Categories

  • Revenue Cycle & Billing Services
  • Denials, Appeals & AR Recovery
  • Compliance, Audit Readiness & Documentation
  • Operations Optimization & Program Growth

Behavioral Health Consulting – Service Areas

Compliance & Audit Readiness

  • OASAS / OMH compliance support (policies, workflows, documentation standards)
  • Chart audits & corrective action plans (clinical and billing risk reduction)
  • Joint Commission readiness (mock surveys, EOC readiness, documentation trace reviews)
  • HIPAA + 42 CFR Part 2 privacy/compliance workflows
  • Incident reporting processes & training records readiness
  • Supervision structure & credential verification (LMSW/LCSW/LMHC/CRPA)

NY-Focused Specialty Areas (optional but strong)

  • OASAS Part 822 outpatient workflows
  • OMH Article 31 clinic operations
  • Co-occurring / integrated program support
  • OTP/Medication operations consulting