Patient Access Services
Registration data review, insurance eligibility and benefits verification, prior authorization management and patient cost estimates before the date of service.
Healthcare RCM Services
Revenue Cycle Management Services for Healthcare Providers
ClainetRCM manages your revenue cycle end to end, from the first eligibility check to the last patient payment. Certified coders file claims within 24 to 48 hours, your AR is worked every 14 days, and every month you see exactly what was billed, paid, denied and recovered.
- AAPC and AHIMA certified coders
- HIPAA compliant, BAA signed
- Practices in all 50 states
- No setup fee, no long-term contract
Last updated October 2026.
24-48 hrsFrom charge capture to claim submission
14 daysHow often your full AR aging is worked
7-14 daysBusiness days to onboard your practice
What Is Revenue Cycle Management in Healthcare?
Revenue cycle management (RCM) is the financial process a healthcare practice uses to track every patient encounter from scheduling to final payment. It covers registration, insurance eligibility, prior authorization, coding, claim submission, payment posting, denial management and patient collections.
The revenue cycle begins before the patient is seen. It starts when the appointment is booked and coverage is verified, and it ends only when the balance on that visit is zero. Medical billing is one stage in the middle. RCM is the whole chain.
That distinction matters because a lot of revenue is not lost at the claim itself. It is lost earlier, when eligibility was not checked or an authorization was missed, or later, when a denial was never appealed. Revenue cycle management services put one team in charge of every stage so the handoffs stop leaking money.
Signs your revenue cycle needs attention
- Denials are rising and nobody can say why
- AR over 90 days keeps growing
- Claims go out a week or more after the visit
- Billing depends on one or two people
- You are not sure payers are paying your contracted rates
- Month-end reports are late, thin or missing
The Healthcare Revenue Cycle, Stage by Stage
End-to-end revenue cycle management means every stage below has an owner, a deadline and a report.
| Stage | What happens | What ClainetRCM does |
|---|---|---|
| Patient access | Scheduling, registration, insurance capture | Verify demographics and coverage through eligibility and benefits verification before the visit |
| Authorization | Payer approval for services that need it | Request, follow and track every prior authorization to a decision |
| Coding and charge capture | Documentation becomes ICD-10, CPT and HCPCS codes | Certified coders assign and audit codes through our medical coding services |
| Claim submission | Claims are scrubbed and sent to payers | Clean claims filed within 24 to 48 hours by our medical billing team |
| Payment posting | ERAs and EOBs are posted and reconciled | Post line by line and flag underpayments against your contracted rates |
| Denials and AR | Unpaid and denied claims are worked | Denial management and AR follow-up on a 14-day cycle |
| Patient collections | Statements and balances after insurance | Clear statements, reminders and payment-plan support |
| Reporting | Performance is measured and reviewed | Monthly reporting on collections, denials, days in AR and aging by payer |
End-to-End RCM Services
Take the full cycle, or start with the stage that is costing you the most and add the rest later.
Coding and Charge Capture
ICD-10-CM, CPT and HCPCS coding by AAPC and AHIMA certified coders, charge entry and validation, and coding audits that catch errors before the claim is built.
Claims Management
Electronic claim submission, claim status monitoring, rejection fixes, and corrected claims refiled within 24 to 48 hours.
Payment Posting
ERA and EOB posting, payment reconciliation, contractual adjustment review, refund processing and underpayment identification.
AR and Denial Management
Aging analysis, insurance follow-up, root-cause denial review, appeals and patient balance follow-up, worked every 14 days.
Analytics and Reporting
KPI tracking against your own baseline, denial trend analysis by payer and reason, and clear recommendations each month.
Credentialing and Enrollment
Provider credentialing, payer enrollment and licensing upkeep, so claims are not held up by enrollment gaps.
The RCM Metrics We Report Every Month
You cannot manage a revenue cycle you cannot see. These are the numbers in your monthly report.
| Metric | What it tells you | Commonly cited target |
|---|---|---|
| Days in AR | How long it takes, on average, to get paid | Under 40 days |
| Clean claim rate | Share of claims accepted on first submission | 95% or higher |
| Denial rate | Share of claims the payer denies | Under 5% |
| Net collection rate | How much of the collectible amount you actually collected | 95% or higher |
| AR over 90 days | How much of your receivables is at risk of never being paid | No more than 15% to 20% of total AR |
| Charge lag | Days between the visit and the claim | Two days or less |
Targets are widely used industry benchmarks and vary by specialty and payer mix. We report your actual numbers against your own starting point.
How We Take Over Your Revenue Cycle
A structured handover, with no gap in claim submission.
Free revenue audit
We sign a Business Associate Agreement, then review 90 days of remittance data or a current aging report and show you which claims were underpaid, denied or never worked.
Secure access
When you decide to go ahead, we set up access to your EHR, practice management system, clearinghouse and payer portals.
Parallel run
We work alongside your current process for a short period, so nothing stops going out the door during the switch.
Go live in 7 to 14 business days
From go-live, charges become claims within 24 to 48 hours and denials are reworked as they post.
14-day AR cycle
Your full aging report is reviewed and worked every 14 days, payer by payer, oldest and largest first.
Monthly review
You get a monthly report and a plain-language summary of what moved, what is stuck and what we are doing about it.
Why Choose ClainetRCM as Your Revenue Cycle Management Company
Certified people, not just software
Every claim is scrubbed by an AAPC or AHIMA certified coder for eligibility, modifiers, medical necessity and payer-specific edits.
We chase what others write off
Underpayments against your contracted rates, unbilled encounters and stalled claims are pursued, and each recovery appears as a line item in your report.
We work in your system
We work inside most major EHR and practice management platforms. No migration, no new license, no retraining your staff.
Pricing tied to results
Pricing starts at 2.29% of monthly collections, with no setup fee and no long-term contract. If we stop earning your business, you can leave.
Compliance built in
HIPAA compliant workflows, a signed BAA with every client, and coders who track ICD-10, CPT and payer policy updates.
A dedicated team
You work with a consistent team that knows your specialty, your payers and your goals.
Outsourced Revenue Cycle Management in All 50 States
A revenue cycle in Florida does not run on the same rules as one in Ohio. State Medicaid programs, Medicare Administrative Contractors, Medicare Advantage plans and commercial payers each have their own enrollment steps, filing limits and medical policies.
ClainetRCM provides healthcare revenue cycle management for independent practices, groups, clinics and facilities nationwide, and builds each account around the payers that hold share in your state.
Revenue Cycle Management: Frequently Asked Questions
Revenue cycle management is the process healthcare providers use to track and collect revenue for each patient encounter, from scheduling and insurance verification through coding, claim submission, payment posting, denial management and patient collections.
Medical billing is the part of the cycle that creates, submits and follows up on claims. Revenue cycle management is broader. It also includes the front-end work that prevents denials, such as eligibility verification, prior authorization and credentialing, and the back-end analysis that shows why money is being lost.
The revenue cycle begins when the appointment is scheduled, not when the claim is filed. Registration accuracy, eligibility verification and prior authorization all happen before the visit, and errors at this stage cause a large share of denials.
Yes. Coding sits in the middle of the cycle. It translates clinical documentation into the ICD-10, CPT and HCPCS codes payers use to decide what to pay, so coding accuracy directly affects both reimbursement and denial rates.
RCM companies typically charge a percentage of collections, which varies with specialty, volume and scope. ClainetRCM's pricing starts at 2.29% of monthly collections, with no setup fee and no long-term contract. See pricing.
We work inside most major systems, including Epic, athenahealth, eClinicalWorks, NextGen and others. You keep your current software, and we adapt to your workflow.
Start with the front end: verify eligibility before every visit and track prior authorizations. Then shorten charge lag, scrub claims before submission, work denials within days rather than weeks, and review AR on a fixed schedule. Finally, measure days in AR, denial rate and net collection rate every month.
Onboarding takes 7 to 14 business days. We sign a BAA, set up secure access and run in parallel with your current process until the handover is clean.
Find Out What Your Revenue Cycle Is Leaving Unpaid
Talk to an RCM specialist about your current denial rate and AR aging. Pricing starts at 2.29% of monthly collections, with no setup fee, no long-term contract, and onboarding in 7 to 14 business days.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.