Medical Billing

1. Accurate Charge Entry & Validation

RCM Plus begins billing with precise charge entry, ensuring:

• Services are entered exactly as documented

• CPT, ICD-10, and modifiers align correctly

• Place of service and rendering details are accurate

This step prevents front-end errors that lead to rejections and downstream denials.

The RCM Plus Medical Billing Framework

At RCM Plus, medical billing is not just claim submission. It is a controlled, compliance-driven revenue process designed to maximize collections while minimizing denials, delays, and audit risk.

Our billing model covers the entire revenue cycle, from charge entry to final payment resolution.

2. Coding Integrity & Compliance

Our billing process follows strict coding integrity standards to ensure:

• Correct CPT and ICD-10 code selection

• Proper modifier application

• No overcoding, undercoding, or unbundling

RCM Plus balances compliance with revenue optimization, ensuring services are billed correctly and defensibly.

3. Medical Necessity Alignment

Before submission, claims are reviewed for:

• Diagnosis-to-procedure justification

• Payer medical necessity rules

• LCD/NCD alignment where applicable

This step directly reduces medical necessity denials and recoupment risk.

4. Clean Claim Submission

RCM Plus focuses on first-pass acceptance by ensuring:

• Claims meet payer-specific formatting requirements

• Timely filing rules are followed

• Clearinghouse edits are resolved proactively

Clean claims move faster and get paid sooner.

5. Payer-Specific Billing Rules Management

Each payer behaves differently. RCM Plus manages:

• Medicare, Medicaid, and commercial payer rules

• State-specific and plan-specific billing requirements

• Updates to payer policies and reimbursement logic

This reduces preventable denials caused by payer rule mismatches.

6. Denial Management & Root Cause Resolution

RCM Plus does not just rework denials, we analyze them. We:

• Categorize denials by reason and payer

• Identify recurring patterns

• Implement corrective actions to prevent repeat issues

This ensures denials decrease over time, not recycle.

7. Payment Posting & Reconciliation

Accurate posting is critical to financial clarity. RCM Plus ensures:

• Correct application of payments and adjustments

• Identification of underpayments

• Reconciliation against contracted rates

This protects revenue that often goes unnoticed.

8. Accounts Receivable (AR) Follow-Up

Our AR teams actively pursue:

• Aging balances

• Unpaid and partially paid claims

• Payer delays and inconsistencies

The focus is resolution, not passive aging

9. Compliance Monitoring & Risk Control

RCM Plus integrates compliance into daily billing operations by:

• Monitoring billing behavior trends

• Flagging high-risk codes and patterns

• Aligning billing practices with audit readiness

Compliance is continuous, not reactive.

10. Transparent Reporting & Performance Tracking

RCM Plus provides clear visibility into billing performance, including:

• Collections and aging reports

• Denial trends

• Provider and payer-level insights

This allows practices to make informed financial decisions.

The RCM Plus Medical Billing Philosophy

RCM Plus medical billing is built to:

• Protect provider revenue

• Reduce denials and payment delays

• Maintain long-term compliance

• Support sustainable practice growth

By managing coding accuracy, billing execution, payer rules, and follow-up together, RCM Plus delivers a billing process that is efficient, defensible, and results-driven.