- Verify insurance eligibility and benefits before every visit
- Confirm prior authorizations for services that require them
- Capture accurate patient demographics and insurance at registration
- Code accurately with current CPT/HCPCS/ICD-10 and correct modifiers
- Ensure documentation supports every code billed
- Scrub claims for errors before submission
- Submit claims promptly to stay within timely-filing limits
- Post payments and reconcile against ERAs/EOBs
- Track and work every denial by reason and payer
- Monitor clean claim rate, days in A/R, denial rate, and net collection rate
RCM Resources to Empower You
Discover guides, whitepapers, and FAQs to optimize your revenue cycle management and boost financial outcomes nationwide.
Valuable RCM Resources
Our curated resources help providers nationwide streamline billing, reduce denials, and enhance RCM from rural clinics to urban centers.
Ultimate Guide to RCM Success
Learn best practices for claims, denials, and patient payments to boost financial performance.
View ChecklistWhitepaper: Reducing Denials
Explore strategies to minimize denials, with insights on prevention and appeals.
View ChecklistMedical Billing FAQs
Answers to common billing questions, covering coding errors and payer policies.
Explore FAQsOutsourcing Checklist
Key considerations for outsourcing billing, ensuring a seamless transition.
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RCM Success Checklist
A practical, print-friendly checklist for a healthy revenue cycle. Work these in order and revisit them regularly.
Denial Prevention Checklist
Most denials are preventable. Confirm each of these before a claim goes out.
- Eligibility and benefits verified at the visit
- Prior authorization obtained and documented where required
- Patient and insurance data validated at registration
- Codes and modifiers accurate and current
- Documentation supports medical necessity and the level billed
- Coordination of benefits confirmed for patients with more than one plan
- Claim scrubbed for errors before submission
- Claim filed within the payer’s timely-filing window
- Denials tracked by reason and appealed promptly
- Recurring denial causes fixed at the source, not just reworked
Medical Billing FAQs
What is the difference between a denial and a rejection?
A rejection is stopped before processing due to a data or format error and can be corrected and resubmitted; a denial is a processed claim the payer decided not to pay, which usually needs a corrected claim or appeal.
How can we reduce claim denials?
Verify eligibility every visit, confirm authorizations, code accurately with supporting documentation, scrub claims before submission, and work denials promptly. See our denial guide.
What RCM metrics should we track?
Clean claim rate, days in accounts receivable (A/R), denial rate, and net collection rate. See RCM KPIs to track.
Where can I look up billing terms?
Our plain-English RCM & medical billing glossary defines the key terms.