Revenue cycle management · Physician groups & health systems
Every claim,
tracked to zero balance.
Riveris works the full cycle inside your EHR: eligibility, coding, submission, posting, denials and AR. You keep the patients. We keep the money moving.
The claim journey
Ten checkpoints.
We own all of them.
A claim fails quietly. It fails at eligibility on day zero and you find out on day 47. Select any checkpoint to see what happens there, and what it costs when it's skipped.
Where the money goes
Revenue doesn't vanish. It leaks.
Three points in the cycle account for most of it. Each one is fixable, and each one needs a different team.
Bad data at the door
- Coverage never verified, or verified once and never rechecked
- Missing or expired prior authorization
- Demographic and subscriber mismatches
- Copay and deductible never discussed with the patient
Work done, not billed
- Charges never captured from the encounter
- Undercoded E/M levels and missed modifiers
- Documentation that won't survive an audit
- Payer-specific coding rules applied inconsistently
Denials nobody works
- Low-dollar denials written off instead of appealed
- AR aging past 120 days and past timely filing
- Underpayments against contracted rates, unnoticed
- Credit balances and unapplied cash sitting open
AR aging
The buckets tell
the whole story.
Money past 90 days collects at a fraction of its face value. Money past 120 often doesn't collect at all. The job is to keep the curve front-loaded, not to chase it later. The shapes below are illustrative, not client results.
Revenue loss calculator
You work too hard to lose revenue like this.
Denied claims, absorbed underpayments and money stuck in aging AR all cost real cash. Enter your numbers and see what is slipping through.
Directional estimate using industry benchmarks, not your data. Rework labor assumes $25 per denial touch. Recovery estimates use illustrative assumptions and are not a guarantee of actual recoveries. Cash tied up in AR is estimated above a 28-day reference point. A remit review against 90 days of your 835s produces the real figure.
The improvement plan
How performance actually improves.
Not by working harder on the same broken process. By measuring the baseline honestly, fixing causes rather than symptoms, and holding the gains with governance that doesn't lapse after month three.
Verify coverage twice
Once at scheduling, once within 48 hours of service. Plans lapse, patients switch employers, and Medicaid redeterminations move people off coverage without anyone telling the practice.
Scrub against the payer, not the standard
Generic claim edits catch generic errors. Most rejections come from a specific payer's specific rule, so the edit library has to be built per payer and updated when policies change.
Work AR by deadline, not by dollar
Chasing the biggest balances first feels rational and loses money. A $180 claim two weeks from timely filing is more urgent than a $4,000 claim with ninety days left.
Route every denial to a cause
Appealing a denial recovers one claim. Finding which checkpoint produced it stops the next hundred. Every CARC gets mapped back to a step and an owner.
Audit coding against documentation
Sample coder output monthly and score it. Undercoding is invisible in every standard report because nothing denies. It only shows up when someone checks the note against the code.
Reconcile cash daily
Post to the bank every day, not every month. Adjustments posted as write-offs hide denials, and unapplied cash sitting in suspense makes every downstream metric wrong.
What we run
Take the whole cycle, or take one bottleneck.
Every function below runs in your systems, on your workflows, with named people accountable for named metrics.
Eligibility & benefits
Real-time 270/271 checks before the visit, re-verified at service. Coverage, plan level, copay, deductible and coordination of benefits captured up front.
Prior authorization
Requests initiated, tracked and escalated to determination. Expiry and visit-count monitoring so authorizations don't lapse mid-course.
Medical coding
Certified coders assigned by specialty. E/M leveling, surgical coding, modifier accuracy and documentation queries back to the provider.
Claim submission
Payer-specific scrubbing before the 837 leaves. Clearinghouse rejections worked same-day, not left in the queue.
Payment posting
ERA and manual posting with line-level accuracy. Contractual adjustments, patient responsibility and unapplied cash reconciled daily.
Denial management
Every denial categorized by CARC, root-caused, appealed with the right documentation, and fed back upstream so it stops recurring.
AR follow-up
Worked by aging bucket and by payer, prioritized on recoverability rather than dollar value. Timely-filing deadlines tracked as hard dates.
Underpayment recovery
Every payment checked against your contracted fee schedule. Variances disputed with the payer, not absorbed.
Credentialing
Enrolment, revalidation and payer roster maintenance so a new provider can bill from day one instead of month four.
Reporting & analytics
Daily cash, denial trend by payer and CPT, coder-level accuracy, AR aging. Built on your definitions, not a generic benchmark.
Denial intelligence
We read the code.
Then we fix the cause.
A denial code tells you what happened. It doesn't tell you why it keeps happening. Every denial we work gets categorized, appealed and traced to the step that produced it, so the same claim doesn't come back next month.
- Predictive flagging of claims likely to deny before submission
- Root-cause categorization by CARC, payer and originating checkpoint
- Appeal packets assembled with the documentation each payer requires
- Payer policy monitoring so edits update before denials arrive
- Prevention feedback loop back into coding and eligibility
- Underpayment and contract variance detection on every remit
What changes
Before and after the handover.
| Focus | Today | With Riveris |
|---|---|---|
| Process | Billing split across front desk, a coder, and whoever has time. Steps get skipped when someone is on leave. | One accountable team across all ten checkpoints, with documented handoffs and cover for every role. |
| Cash | Collections swing month to month. Forecasting is guesswork and a slow payer can stall payroll. | Daily cash posted and reconciled. Predictable AR curve you can plan hiring and capital against. |
| Denials | Worked when there's capacity. Low-dollar denials get written off because chasing them costs more than they're worth. | Denials triaged and worked to an appropriate resolution, prioritized by recoverability, with root cause pushed back upstream. |
| Visibility | A monthly report that tells you what happened, four weeks after you could have done anything about it. | Live dashboards on denial trend, coder accuracy, payer performance and AR aging. Weekly review with your lead. |
| Scale | Adding a provider or a location means hiring, training and a three-month dip in collections. | Capacity added before go-live. Credentialing runs in parallel so new providers bill from week one. |
Coverage
Deep know-how across specialties and facility types.
Billing rules are not generic. An anaesthesia unit calculation, an ASC facility fee and an infusion J-code each fail differently, so coders and AR staff are assigned by specialty rather than pooled.
Facility types
- Inpatient care facilities
- Ambulatory surgery centers
- Freestanding emergency rooms
- Rehabilitation hospitals
- Long-term acute care (LTACH)
- Skilled nursing facilities
- Home health
- Urgent care
Medical specialties
- Anaesthesia
- Cardiology
- Emergency medicine
- Gastroenterology
- Internal medicine
- Nephrology
- Oncology
- Pulmonary disease
- Rheumatology
Surgical & procedural
- Orthopaedics
- Neurosurgery
- Colorectal surgery
- Interventional pain management
- OB/GYN
- Ophthalmology
- Urology
- Radiology
- Physical therapy
Engagement
Three ways to work with us.
Not every group needs the whole cycle outsourced. Start where it hurts.
Modular
Hand us one step, whether that is coding, denials, AR follow-up or eligibility, and keep the rest in house. Plugs into your existing workflow without changing your systems.
End to end
We run everything from eligibility to zero balance. Your staff stops billing entirely and goes back to running the practice. Dedicated account lead, weekly governance, monthly business review.
Extended business office
A parallel team that clears legacy AR, works a denial backlog, or absorbs volume through a system conversion, without disturbing your existing operation.
Questions
Before you ask.
What exactly is revenue cycle management?
It's every step between a patient booking an appointment and the account closing at zero balance: eligibility and prior authorization, charge capture, coding, claim submission, payer adjudication, payment posting, denial management and AR follow-up. When those steps are owned by different people with different priorities, claims fall through the gaps between them.
Do we have to change our EHR or practice management system?
No. We work inside whatever you already run. Our teams are trained on the major platforms and we build the workflow around your configuration, not the other way round.
How long does transition take?
Typically four to six weeks from signature to full production, run in parallel with your current process so collections don't dip. Credentialing and payer enrolment start on day one because those have the longest lead times.
What happens to our billing staff?
Most groups redeploy them into patient-facing or supervisory roles rather than making them redundant. Some keep a small internal team for oversight and patient escalations while we handle production. We'll plan that with you before go-live.
How are you paid?
End-to-end engagements are a percentage of collections, so we only earn when you get paid. Modular and project work is priced per claim, per FTE or on contingency. No fee is tied to activity volume, only to resolution.
Which metrics will we actually see?
Clean claim rate, first-pass resolution, denial rate by payer and by CPT, days in AR, AR over 90 and over 120 days, net collection rate, and coder accuracy by individual. Defined against your baseline so the numbers mean something on day one.
Can you take on our aged AR backlog?
Yes, as a separate workstream. We triage the backlog by recoverability and timely-filing deadline, work what's still collectable, and give you a written position on the rest so you can close the books honestly.
Start here
Schedule a Free Practice Analysis
We'll come back with your denial concentration, your underpayment exposure and what's recoverable from your aging AR. No cost, no commitment, and you keep the analysis either way.
What you get back
A written analysis built from your own data, not a generic benchmark report.
- Denial concentration by payer, CPT and denial code
- Underpayment exposure against your contracted rates
- AR aging with timely-filing deadlines flagged
- An estimate of what is realistically recoverable
We sign a BAA before receiving any data. Nothing is shared with anyone outside your engagement team.
Prefer to talk first? Call +1 434-424-4112 or email sales@riverisrcm.com.