Revenue cycle management services
One U.S.-based team that handles each step from the eligibility check to the final payment, working inside the EHR and PM system you already use.
Most revenue problems in a practice start long before a claim is denied. A plan that termed last month, a missing authorization, a modifier left off an E/M visit, or a payment posted to the wrong line all show up weeks later as aging A/R. Revenue cycle management means someone is watching each of those handoffs every day and fixing the cause along with the claim.
SFA Solutions runs the full cycle for you: insurance verification and prior authorizations, coding review, claim review against applicable billing, coding and payer-specific rules (10,000+ in our workflow) to help identify preventable errors before submission, a 24-hour target for submitting clean claims after final review, ERA and EFT posting, denial work, A/R follow-up and patient statements. You get one point of contact and a monthly report that shows days in A/R, first-pass rate, denial rate and net collection rate. Pricing depends on monthly collections: a flat $500 a month under $15,000 in insurance collections, a flat $1,000 a month from $15,000 through $30,000, and 3.5% of insurance collections above $30,000, with no long-term contract. Provider credentialing is included free with every billing plan.
Who this is for
Full RCM fits practices that do not want to staff a billing department: solo providers and small groups in primary care, behavioral health, nurse practitioner practices and procedure-heavy specialties such as cardiology, gastroenterology and orthopedics. It also suits practices whose in-house biller has left, groups adding a second location, and new practices that need credentialing and billing set up at the same time.
Related services
What our revenue cycle management service covers
Front-end checks
Eligibility and benefits verified before the visit, with prior authorizations requested and tracked so coverage problems are caught early.
Coding and charge review
CPT, HCPCS, ICD-10-CM and modifier review against NCCI edits and payer policy before anything leaves your system.
Claim submission
Claims are reviewed against applicable billing, coding and payer-specific rules before submission to help identify preventable errors. Most clean claims go out within 24 hours.
Payment posting
ERA and EFT posting line by line, with underpayments flagged against your contracted rates instead of written off.
Denials and A/R follow-up
Denials worked by root cause and unpaid claims followed up by aging bucket, with appeals filed within each payer's deadline.
Reporting and credentialing
Monthly KPI reporting by provider and payer, plus credentialing and recredentialing included free with every billing plan.
How we deliver it
Free audit
We look at your A/R aging, denial and payer-mix summaries (no patient identifiers, and no patient data before a signed BAA) and walk you through where revenue may be slipping before you sign anything.
Go-live
We can typically begin within 24 hours of receiving system access. No software change and no data migration project.
First 60 days
We clean up the backlog first: open denials, unbilled encounters and old A/R, while keeping new claims moving on a daily schedule.
Every month
You get a KPI report and a short review call covering payer trends, denial causes and the fixes we made upstream.
Revenue cycle KPIs and commonly cited healthy ranges
| KPI | What it measures | Healthy range |
|---|---|---|
| Days in A/R | Average days from service to payment | Under 40 days; strong practices run 30 to 35 |
| A/R over 90 days | Share of open A/R older than 90 days | Under 15% of total A/R; under 10% is strong |
| First-pass rate | Claims paid or accepted on first submission | 90% or higher; top performers reach 95%+ |
| Denial rate | Claims denied on first submission | Under 5%; many practices run 5% to 10% |
| Net collection rate | Collected vs. what was collectible after contractual adjustments | 95% or higher |
| Charge lag | Days from date of service to claim submission | 1 to 3 days or less |
Revenue Cycle Management for your specialty
We bill for 28+ specialties. These are the ones we work with most.
Nurse Practitioner billing
Billing for NP-led and physician-NP practices, from the 85% Medicare rate and incident-to rules to split/shared visits and getting each NP credentialed under the right NPI.
Learn moreInternal Medicine billing
Billing for internists who manage complex, chronic patients, with E/M levels, wellness visits and care management codes captured when the documentation supports them.
Learn moreOphthalmology billing
Eye exam codes, refraction, diagnostic testing, cataract globals and high-cost injectable drugs all follow their own rules. Ophthalmology is one of the specialties we bill most often.
Learn moreQuestions about revenue cycle management
What is the difference between medical billing and revenue cycle management?
Medical billing usually covers claim creation, submission and payment posting. Revenue cycle management adds the steps before and after: eligibility, prior authorizations, coding review, denial prevention, A/R follow-up, patient balances and reporting. Most lost revenue comes from those surrounding steps, so we handle them together.
How much does outsourced RCM cost?
SFA prices on monthly collections: practices collecting under $15,000 a month pay a flat $500 a month, practices collecting $15,000 through $30,000 pay a flat $1,000 a month, and practices collecting more than $30,000 pay 3.5% of insurance collections. There is no long-term contract, and you keep the software you already use. After the free audit, we can quote based on your volume and specialty.
Do we have to change our EHR or practice management system?
No. We work inside your existing system, including Epic, eClinicalWorks, athenahealth, NextGen, Kareo/Tebra, AdvancedMD, DrChrono, Office Ally and 50+ others. Your staff keeps the same workflow for scheduling and charting.
How quickly will we see results?
New claims usually benefit first, since pre-submission claim review and our 24-hour target for clean claims start at go-live. Old A/R and open denials take longer, usually 60 to 90 days to work through, depending on how far back they go and each payer's appeal deadlines.
Who will we talk to day to day?
You get a named account manager on our U.S.-based team, reachable by phone at (737) 600-8899 or email Monday to Friday, 8am to 5pm Central time. The same person runs your monthly KPI review.
Start with a free review
Tell us a little about your practice. We will look at where revenue cycle management is costing you money today and walk you through what we find.
- No commitment
- Reply from an RCM specialist, typically within one business day
- No patient records needed to start
Get a free review
An RCM specialist typically replies within one business day.