Honest answers to the questions Michigan practice owners actually ask us before signing on. Plus a glossary, in case the RCM jargon ever gets in the way.
Most in-house billers are excellent but stretched thin — covering eligibility, charge entry, payment posting, denials, and patient calls all at once. We replicate that team's coverage with depth in every function: a coding specialist, a denials specialist, a payment poster, and a dedicated account manager. Plus, you have full coverage when someone gets sick or quits — you no longer have a single point of failure.
We charge a flat percentage of net collections — typically 4–8% depending on volume, specialty complexity, and the scope of services. No setup fees on standard engagements. No clearinghouse, statement, or postage fees. We give you a custom quote after the free audit because pricing depends on what you actually need.
The first 90 days are committed (so we can do the heavy onboarding work without losing money on it), then it's month-to-month. If we're not earning our keep, you walk away with 30 days' notice. Most clients stay for years, but we never want a contract holding you here.
We're EHR-agnostic. We've worked extensively with Athenahealth, eClinicalWorks, Kareo/Tebra, AdvancedMD, NextGen, DrChrono, Practice Fusion, ChartLogic, AthenaIDX, and many others. If you have an EHR with secure remote access and a billing module, we can work in it.
Most practices are fully live within 21–30 days. The longest items are payer enrollments (especially Medicare) and clearinghouse setup. We've done it faster when needed and we pace it according to your timeline — there's no benefit to rushing.
No. Our patient billing team answers calls under your practice name with a phone number that routes to us. Statements are branded to your practice. Patients experience us as your back office — because that's what we are.
Yes. Encrypted data transfer (TLS 1.3), encrypted storage (AES-256), role-based access controls, full audit logs, signed Business Associate Agreement with every client and subcontractor, annual security review, and ongoing staff HIPAA training.
Yes — both initial enrollment for new providers and re-credentialing/revalidation for existing ones. We manage CAQH, PECOS, NPPES, and direct payer enrollments for Medicare, Medicaid, BCBS, Priority Health, Meridian, Molina, and the major commercial carriers.
We can run an A/R cleanup project on your legacy aging — typically priced as a fixed contingency fee on what we recover. Many practices recover tens of thousands from claims that were sitting in aged buckets nobody was working anymore.
In our experience, most practices coming from a stressed in-house operation see net collections improve 8–15% in the first six months — driven mostly by fewer denials, better coding, and aged A/R recovery. The free audit will give you a specific dollar estimate for your practice before you commit to anything.
An always-on KPI dashboard (collections, A/R days, denials, payer mix, per-provider productivity), a written monthly executive report, and a 30-minute video review with your account manager. Plus quarterly strategic deep-dives. If you want a custom report, we'll build it.
Because Michigan payers — BCBS Michigan, Priority Health, Meridian, Molina, McLaren, HAP — have their own rules, reimbursement quirks, and payer reps. National RCM companies treat Michigan as just another market; we treat it as home. That local knowledge translates directly into faster reimbursements.
A 30-minute discovery call. If we both think there's a fit, we'll do a free 90-day audit on de-identified data. You walk away with a written report showing where revenue is leaking — even if you decide not to engage us, the audit is yours to keep.
If you've ever read an RCM proposal and gotten lost in jargon, this is for you.
The percentage of claims that pass through to the payer without rejection or correction on the first submission. Industry benchmark is 95%; we average 98%.
Average number of days it takes to collect after a claim is submitted. Lower is better. Best-in-class practices run 25–30 days; we target ≤30.
Percentage of submitted claims that get denied by payers. Best-in-class is under 5%; many practices run 8–15% before they fix root causes.
Electronic Remittance Advice / Explanation of Benefits — the document the payer sends explaining what they paid and why. ERAs post automatically; EOBs require manual posting.
The process of pulling encounter data from the EHR and turning it into billable charges. Missed charges = lost revenue forever.
Recording the codes, modifiers, and units for a visit into your billing system, so a claim can be generated.
Indicates a significant, separately identifiable E/M service performed on the same day as a procedure. Misuse is a top audit trigger; correct use is real revenue.
National Correct Coding Initiative — Medicare's bundling rules that prevent unbundling. Run a scrub against these or your claims will get denied.
Payer pre-approval for a service. Missing it usually means the claim won't pay — even if the service was medically necessary.
When a patient has more than one insurance, COB determines the order of payment. Wrong COB = automatic denial.
Council for Affordable Quality Healthcare — the universal credentialing database payers pull from. If your CAQH isn't current, your enrollments stall.
Provider Enrollment, Chain, and Ownership System — Medicare's online enrollment portal. Required for any provider billing Medicare.
Medicare's measure of provider work, practice expense, and malpractice expense per service. Used to benchmark productivity and reimbursement.
A two-digit code on every claim indicating where service was rendered (office, telehealth, ASC, hospital). Wrong POS = wrong reimbursement or denial.
The acknowledgment file from the clearinghouse confirming whether each claim was accepted or rejected. We monitor every one.
When a payer pays less than the contracted rate. Without active monitoring, underpayments quietly become write-offs.
Email us or pick up the phone. No sales pressure — we'll just answer your question.
