Stage 3 — Practice management
I’ve spent more than 25 years in healthcare operations, including billing, collections, payer relations, staffing, compliance and the systems that connect them. One thing I’ve learned is that revenue problems often begin long before a claim is submitted. I understand how frustrating it is to provide excellent care and then struggle with denials, slow payments, aging receivables or reports that don’t explain what needs attention. Our approach starts by listening, reviewing your numbers and understanding how your practice really operates. We look at eligibility, authorizations, coding, claims, payments, denials and follow-up together, then help establish the standards and accountability needed to improve performance. You’ve earned that revenue. Our job is to help you collect it more effectively without losing sight of your patients.
Watch
A short walk through how MedCoShare approaches revenue cycle management — starting with your numbers, and the operation behind every claim.
It was earned at the visit. The work is making sure the process between the visit and the deposit doesn't lose any of it.
Revenue rarely gets lost in the billing department. It gets lost at intake when coverage isn't verified, at the visit when documentation doesn't support the code, at the front desk when an authorization is caught after the fact, and in the gap where nobody owns denials.
Which is why a billing service that processes whatever you hand it can only ever help so much.
We connect workflow, people, documentation, technology, payer requirements and reimbursement, because each one influences financial performance. In practice that means the first thing we do is read your KPIs — collection rate, days in A/R, denial rate by payer — and show you where the money is actually going. The recommendation comes after that, not before.
You earned it at the visit. The rest is making sure it arrives.
Claim submission is one step of ten, and it's rarely the step costing you. Here is the full chain, in the order money moves through it.
Confirming active coverage and benefits before the visit, so the claim starts out viable.
Securing approvals ahead of service rather than discovering the requirement afterwards.
Accurate CPT, ICD-10 and modifier selection — the difference between a paid claim and an audited one.
Making sure work performed actually reaches a claim. Missed charges never appear in any report.
Clean claims out the door the first time, with scrubbing that catches errors before the payer does.
Posting against contracted rates, so underpayments surface instead of being recorded as paid in full.
Categorizing denials by root cause and payer, then fixing the cause rather than reworking the symptom.
Working the denials worth working, within filing limits, with documentation that holds up.
Aging worked by bucket and by payer, so older balances get resolved rather than quietly written off.
Clear statements, workable payment options, and monthly reporting that explains the numbers.
Before we recommend anything, we read your KPIs. Most practices have never seen all five in one place, and the gap between two of them usually explains the shortfall.
| Metric | Commonly cited target | What it tells you |
|---|---|---|
| Days in A/R | Under 35–40 days | How long your money sits with someone else. A rising trend is the earliest signal something upstream changed. |
| Clean claim rate | 95% and above | The share of claims paid on first submission. Every point below target is rework your staff pays for twice. |
| Denial rate | Under 5% | How often payers say no. The number matters less than whether anyone is categorizing denials by cause. |
| Net collection rate | 95% and above | What you collected against what you were contractually owed. This is where silent underpayment shows up. |
| A/R over 90 days | Under 15–20% | The share of aging genuinely at risk. Past filing limits, most of it is unrecoverable. |
A denial is usually the last step of something that began elsewhere — an intake field nobody filled, a workflow that drifted, a contract nobody reviewed.
Straight answers, before any conversation. If the answer you need isn't here, a short call is the fastest way to get it.
Revenue cycle management is the complete financial process that converts patient care into collected revenue. It begins before the visit with eligibility verification and prior authorization, continues through coding, charge capture and claim submission, and ends with payment posting, denial management, appeals, accounts receivable follow-up and patient balance collection. Claim submission is one step of roughly ten, which is why practices that outsource only billing often see little change.
Medical billing is the act of submitting claims and posting payments. Revenue cycle management covers everything that determines whether those claims get paid at the right amount — eligibility, authorization, coding accuracy, denial root-cause analysis, appeals, A/R strategy and contracted-rate reconciliation. A billing service processes what you hand it. Revenue cycle management asks why you handed it that.
The usual signals are rising days in accounts receivable, a denial rate nobody tracks or appeals, aged A/R that can't be explained payer by payer, and billing knowledge concentrated in one person who could leave. Outsourcing makes sense when a practice can't answer basic questions about its own collections — not simply when patient volume grows.
Under 35 to 40 days is the range most often cited as healthy, though it varies meaningfully by specialty and payer mix. The trend matters more than the absolute figure: days in A/R climbing month over month is usually the earliest visible sign that something changed upstream in eligibility, coding or submission.
The most common causes are eligibility or coverage issues, missing prior authorization, coding and modifier errors, incomplete patient or provider information, credentialing gaps, and filing past the deadline. Denials cluster: in most practices a small number of causes account for the large majority, which is why categorizing them by root cause matters more than reworking them one at a time.
Usually not. We work inside the systems a practice already uses wherever the platform supports it. Where a system is genuinely obstructing collections we'll say so and show you why, but replacing software is a recommendation rather than a precondition.
It depends on specialty, claim volume, payer mix and how much of the cycle you want covered, so a real number requires a look at your actual numbers first. That review is where every engagement starts, and it carries no commitment.
Build it. Grow it. Run it better.
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