Medical billing
Claim creation, submission, and payment posting.
medical billing services →End-to-end RCM · 50+ specialties · all 50 states
Revenue Cycle Management Services for U.S. Healthcare Providers
Revenue cycle management (RCM) is the end-to-end financial process healthcare providers use to track patient revenue from pre-registration through final payment — including billing, coding, credentialing, prior authorization, denial management, and accounts receivable recovery. RevalonMD manages the full cycle for 50+ specialties across all 50 states, targeting a 99% first-pass claim rate.
99% first-pass figure is a RevalonMD target — Based on RevalonMD's managed-billing client portfolio; individual practice results vary based on specialty, payer mix, and documentation quality.
Free audit
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We review your denials, AR aging, credentialing gaps, and coding accuracy, then deliver a written findings summary with an estimated monthly recovery range. No PHI required to book.
99%
First-pass claim acceptance target
RevalonMD metric; HFMA MAP Keys benchmark is 85–90%, top performers 95%+. Founder-verified target.
≤ 38
Days in AR target
Against an MGMA 2025 industry benchmark of 35–45 days; payer- and specialty-dependent.
2.99%
Starting billing rate, % of collections
RevalonMD starting rate; industry RCM fees run 3–8% of collections. Final rate by specialty and scope.
50+
Specialties, all 50 states
AAPC/AHIMA-certified coders assigned by field across all 50 U.S. states.
Benchmarks: HFMA MAP Keys (hfma.org, updated 2025–2026) and the MGMA 2025 Financials and Operations Data Report. RevalonMD targets are founder-verified and stated as targets, not guarantees.
Definition
What is revenue cycle management?
Revenue cycle management (RCM) is the financial process healthcare providers use to track patient revenue from pre-appointment eligibility verification through final payment. It includes billing, coding, credentialing, prior authorization, denial management, and accounts receivable recovery.
That definition sets the border for everything below: RevalonMD owns the whole cycle, not a single phase of it. The distinction that trips up most practices is where billing ends and the revenue cycle begins.
Revenue cycle management is the umbrella. Medical billing is one phase inside it — claim submission and payment posting — while RCM also governs eligibility verification, charge capture, medical coding, credentialing, prior authorization, denial management, and accounts receivable recovery. Outsourcing billing alone leaves the denial and AR phases unmanaged, which is where most net collection is lost.
The Healthcare Financial Management Association defines the revenue cycle as every administrative and clinical function that captures, manages, and collects patient service revenue (HFMA, updated May 2026). A well-run cycle reduces days in AR, raises the first-pass claim rate, and protects the share of collectable revenue a practice actually collects.
Scope
What does RevalonMD’s RCM service include?
RevalonMD's revenue cycle management covers all nine phases: eligibility verification, charge capture, medical coding (CPT 2026 / ICD-10-CM FY2026), claim submission, payment posting, denial management, AR follow-up, patient collections, and monthly performance reporting — managed end-to-end for 50+ specialties across all 50 states.
Each of RevalonMD’s eight service pillars is a phase of one revenue cycle, not a separate vendor relationship. The same accountable team runs all of them — so information never gets lost in a hand-off between billing, coding, and credentialing.
Medical coding
CPT, ICD-10-CM, and HCPCS assignment by certified coders.
medical coding →Medical credentialing
CAQH and PECOS enrollment so claims can be paid at all.
credentialing services →Denial management
CARC/RARC root-cause analysis and coded appeals.
denial management →Prior authorization
Pre-service approvals that prevent front-end denials.
prior authorization →AR recovery
Aging-AR work-down across payer and date-of-service buckets.
accounts receivable recovery →Practice management consulting
Workflow, payer-mix, and fee-schedule optimization.
practice management consulting →Specialties
Specialty-certified coders assigned by field.
specialty billing across 50+ fields →Editorial justification (R-007): the RCM hub links across silos to billing, coding, and credentialing because the revenue cycle umbrella encompasses all three as component phases.
Process
The revenue cycle process: step-by-step
The nine steps of the revenue cycle are: (1) patient pre-registration and eligibility verification, (2) charge capture, (3) medical coding, (4) claim submission, (5) payment posting, (6) denial management, (7) accounts receivable follow-up, (8) patient collections, and (9) performance reporting and analytics.
The nine steps are interdependent: an eligibility failure at step one becomes a denial at step six. RevalonMD runs every step inside your existing EHR and clearinghouse, so defects are caught up front rather than appealed after the fact.
- 1. Pre-registration & eligibility verificationInsurance coverage is verified before the appointment, so eligibility failures are caught before claim submission and front-end denials never form.
- 2. Charge captureThe clinical encounter is converted to billable charges through EHR documentation review. RevalonMD works inside any EHR — no lock-in required.
- 3. Medical codingAAPC- and AHIMA-certified coders assign CPT 2026 (AMA), ICD-10-CM FY2026 (CMS/NCHS, effective October 1, 2025), and HCPCS Level II 2026 (CMS) codes.
- 4. Claim scrubbing & submissionClean claims are submitted via EDI 837 through clearinghouse partners and reviewed against NCCI bundling edits (Q3 2026) before they leave.
- 5. Payment posting & ERA reconciliationEOB/ERA remittances are reconciled, contractual adjustments are posted, and patient responsibility balances are established.
- 6. Denial management & appealsDenials are identified by CARC/RARC code, root cause is analyzed, and appeals are filed inside the timely-filing window.
- 7. Accounts receivable follow-upAging AR is worked by payer and date of service across 30/60/90/120+ day buckets, with a monthly AR-aging report provided.
- 8. Patient statements & collectionsPatient-facing statements are issued and payment plans supported — managed only within BAA-governed systems, never through a non-BAA channel.
- 9. Reporting & performance analyticsA monthly KPI dashboard tracks first-pass rate, days in AR, net collection rate, denial rate, and cost-to-collect against HFMA MAP Keys.
Coding is verified before claims leave the building.
Certified coders assign CPT 2026 (AMA), ICD-10-CM FY2026 (CMS/NCHS, effective October 1, 2025), and HCPCS Level II 2026 (CMS) codes, and every claim is checked against CMS National Correct Coding Initiative (NCCI) bundling edits (Q3 2026) before submission. Code-year references are verified by the Coding Director at each refresh.
Metrics
What KPIs should I track to measure RCM performance?
The five essential RCM KPIs are first-pass acceptance rate (target: 95%+), days in accounts receivable (target: under 35 days for top performers), net collection rate (target: 98%+), denial rate (target: under 5%), and cost-to-collect ratio. HFMA MAP Keys and MGMA benchmarks are the industry standard for all five.
Benchmarks only matter against a named source. The table below sets each KPI against HFMA MAP Keys and MGMA 2025 figures — the industry standards no competitor cites on their RCM pages.
| KPI | Industry benchmark | Top performer | RevalonMD target |
|---|---|---|---|
| First-pass acceptance rate | 85–90% | 95%+ | 99% (target) † |
| Days in accounts receivable | 35–45 days | < 30 days | ≤ 38 days |
| Net collection rate | 95–96% | 98%+ | ≥ 97% |
| Denial rate | 8–10% | < 5% | < 4.5% |
| Cost-to-collect ratio | 4–6% | < 3% | % of collections |
Sources: HFMA MAP Keys (hfma.org/data-and-insights/map-initiative/, updated 2025–2026); MGMA 2025 Financials and Operations Data Report. † 99% first-pass target — Based on RevalonMD's managed-billing client portfolio; individual practice results vary based on specialty, payer mix, and documentation quality.
Track first-pass rate, days in AR, and net collection rate together — they move as a system. Estimate what tighter metrics could recover for your practice below.
The case for outsourcing
Why outsource revenue cycle management?
Outsourcing RCM removes billing overhead, eliminates staff turnover risk, and puts AAPC/AHIMA-certified coders on every claim. Independent practices typically see AR days drop and denial rates fall within 90 days of switching to a full-service RCM partner. RevalonMD provides EHR-agnostic integration, a signed BAA, and dedicated account management.
Benchmarks describe the average; an actual account shows the mechanism. The anonymized engagement below is the pattern RevalonMD sees most often in multi-provider groups.
Operator Example · Multi-specialty ambulatory practice (anonymized), 8 providers. Payer mix: Medicare 40%, commercial 50%, Medicaid 10%.
Before RevalonMD
- Days in AR: 72
- Denial rate: 14%
- First-pass rate: 79%
- Monthly write-offs: $18,400
After 6 months
- Days in AR: 38
- Denial rate: 4.2%
- First-pass rate: 97%
- Monthly write-offs: $4,100
Full RCM takeover: coding audit, credentialing cleanup (CAQH/PECOS), clearinghouse migration, denial root-cause analysis (CARC/RARC review), and AR recovery sprints — a 90-day push on the 120-plus-day aging bucket.
Operator Example — anonymized client data. Results represent one client's experience and are not a guarantee of future outcomes. Individual results vary based on specialty, payer mix, and documentation quality.
Specialty depth
Specialty-specific RCM considerations
RCM complexity varies by specialty. Cardiology requires device and procedure code precision; behavioral health requires modifier and timely-filing management; gastroenterology involves facility vs. professional fee splits. RevalonMD's AAPC/AHIMA-certified coders are trained by specialty, reducing coding errors that lead to denials.
Metrics only travel if the team knows your specialty’s codes and your state’s payers. RevalonMD assigns coders certified in your field rather than rotating generalists across every account.
Cardiology
Device and cath-lab procedure-code precision; E/M leveling accuracy.
Behavioral & mental health
Time-based CPT codes, modifier management, and timely-filing discipline.
Gastroenterology
Facility vs. professional fee splits on endoscopy and procedure claims.
Orthopedics
Global surgical periods and modifier accuracy on bundled procedures.
Internal & family medicine
High-volume E/M coding and chronic-care management capture.
Urgent care
High claim throughput with payer-specific place-of-service rules.
RevalonMD bills for 50+ specialties across all 50 states — the full roster links from the service grid above. For field-specific fee context, download the specialty fee guide.
Pricing
Revenue cycle management pricing
RevalonMD's RCM services start at 2.99% of collected revenue. The percentage-of-collections model means RevalonMD earns only when collections are made. Book a free billing audit for specialty-specific pricing.
The percentage-of-collections model aligns incentives: RevalonMD earns only when a claim is collected, so the fee is paid out of recovered revenue rather than fixed overhead.
2.99%starting rate · % of collected revenue
- Pay only on revenue RevalonMD actually collects
- Certified coding, scrubbing, and denial appeals included
- Payment posting and ERA/EOB reconciliation included
- AR follow-up within timely-filing windows
- Monthly KPI reporting and a dedicated account team
Pricing note: Starting rate; final rate based on specialty, volume, and services included. See the pricing page for details. Industry RCM fees typically run 3–8% of collections. Book a free billing audit for a specialty-specific quote.
Book your free billing auditSee full pricing detail
Compliance
HIPAA compliance and BAA
RevalonMD is a HIPAA-compliant Business Associate. A signed Business Associate Agreement (BAA) is executed with every client before accessing any practice or patient data — as required under 45 CFR 164.308(b) and 164.502(e). No PHI is collected via web form, email, or any non-BAA channel.
Price means nothing if the partner handling your patients’ data is a compliance risk. Here is exactly where RevalonMD’s obligations come from and how PHI is protected.
RevalonMD operates as a HIPAA business associate and signs a Business Associate Agreement with every client before accessing any practice or patient data, as required under 45 CFR 164.308(b) and 164.502(e) (HIPAA Omnibus Rule, updated 2024). Access is role-based, audit-logged, and limited to the minimum-necessary standard; full safeguards are documented on the HIPAA-compliant security practices page.
The billing workflow also supports good-faith estimate (GFE) generation under the No Surprises Act (45 CFR Parts 147 and 149, effective January 1, 2022; enforcement ongoing 2026), so self-pay and out-of-network estimates meet federal price-transparency requirements.
FAQ
Frequently asked questions
Revenue cycle management (RCM) is the financial process healthcare providers use to track and collect patient revenue — from pre-appointment eligibility verification through charge capture, claim submission, payment posting, denial management, and accounts receivable follow-up. A well-managed revenue cycle reduces days in AR, raises the first-pass claim rate, and maximizes net collection (Source: HFMA, hfma.org, updated May 2026).
RCM follows nine steps: (1) patient pre-registration and eligibility verification, (2) charge capture, (3) medical coding, (4) claim scrubbing and submission, (5) payment posting and ERA reconciliation, (6) denial management and appeals, (7) accounts receivable follow-up, (8) patient statement and collections, and (9) performance reporting and analytics. Each step is interdependent — an eligibility failure at step one typically creates a denial at step six.
In medical billing, RCM (revenue cycle management) is the broader system that includes billing as one phase. Medical billing refers specifically to submitting claims and posting payments; RCM adds pre-authorization, eligibility verification, coding oversight, denial management, AR recovery, and reporting. RevalonMD manages the full revenue cycle rather than billing alone (Source: HFMA, hfma.org, updated May 2026).
Medical billing is a subset of revenue cycle management. Billing covers claim submission and payment posting; RCM encompasses the entire patient revenue lifecycle — from scheduling and eligibility through coding, billing, denial resolution, AR recovery, and performance reporting. Outsourcing billing without the full revenue cycle often leaves denial management and AR recovery gaps that erode net collection rates.
RevalonMD's RCM services start at 2.99% of collected revenue, meaning practices pay only when RevalonMD collects (starting rate; final rate based on specialty, volume, and services included). Industry rates typically range from 3% to 8% of collections. For a specialty-specific quote, book a free billing audit at revalonmd.com/contact/.
A first-pass acceptance rate of 95% or above is considered top-performer level per HFMA MAP Keys. The industry average is 85–90%. RevalonMD targets a 99% first-pass rate across its managed-billing client portfolio (individual results vary based on specialty, payer mix, and documentation quality). (Source: HFMA MAP Keys, hfma.org.)
The five most important RCM KPIs are: (1) first-pass acceptance rate (top-performer target: 95%+), (2) days in accounts receivable (top-performer target: under 30 days), (3) net collection rate (top-performer target: 98%+), (4) denial rate (top-performer target: under 5%), and (5) cost-to-collect ratio (top-performer target: under 3%). HFMA MAP Keys and the MGMA 2025 Financials and Operations Data Report are the standard industry benchmarks for all five metrics.
Outsourcing RCM reduces overhead, eliminates billing staff turnover risk, and places AAPC/AHIMA-certified coders on every claim. Independent practices typically see AR days drop 20–40% and denial rates fall within 90 days of switching to a full-service RCM partner. RevalonMD provides EHR-agnostic integration, a signed BAA per HIPAA requirements, a dedicated account team, and monthly performance reporting — with a percentage-of-collections model that aligns incentives.
Who stands behind this page
Methodology: performance figures on this page are RevalonMD operating targets, reviewed every six months and signed off by the Founder before publication — not industry averages presented as guarantees. KPI benchmarks are cited inline from HFMA MAP Keys and the MGMA 2025 Financials and Operations Data Report. Medical-code references name their code year (CPT 2026; ICD-10-CM FY2026; HCPCS Level II 2026) and are verified by the Coding Director before publish.
HFMA MAP Keys, 2025–2026MGMA 2025 Financials & Operations45 CFR 164.308(b), 164.502(e)AMA CPT 2026CMS ICD-10-CM FY2026CMS NCCI edits, Q3 2026CAQH ProView · CMS PECOS
Find out what your revenue cycle is leaving on the table.
Free revenue cycle audit · written findings summary · estimated monthly recovery range. No PHI required to book.