Revenue Cycle Management
Revenue cycle management engineered for clean claims and faster reimbursement.
Telemedia Solutions operates the end-to-end revenue cycle for provider organizations — eligibility and benefit verification, prior authorization, clinical documentation integrity, certified coding, charge capture, claim adjudication and denial recovery — engineered so charges convert to collected reimbursement with the fewest touches and the least leakage.
We treat the revenue cycle as a clinical-financial system: every claim is coded to the documentation, scrubbed against payer edits and worked to zero balance.
- First-pass clean-claim submission
- Certified ICD-10-CM & CPT coding
- Denial prevention and appeals
- Accelerated A/R and net collections
What we deliver
One revenue cycle, managed end to end.
From registration to zero balance, every stage is instrumented, coded to the documentation and worked to resolution — so front-end accuracy, mid-cycle integrity and back-end recovery reinforce each other instead of leaking margin.
Eligibility & benefit verification
Real-time 270/271 eligibility checks, plan and coverage discovery, coordination-of-benefits sequencing and estimated patient responsibility captured before the encounter — eliminating the coverage errors that drive front-end denials.
Prior authorization & medical necessity
Authorization determination and submission, LCD/NCD medical-necessity screening and 278 request tracking, so services requiring pre-approval are documented and cleared ahead of the date of service.
Clinical documentation integrity
CDI review that reconciles the clinical narrative to coded detail — query workflows for specificity, acuity and severity — supporting accurate DRG/APC assignment and defensible risk-adjusted capture.
Certified medical coding
AAPC/AHIMA-credentialed coding in ICD-10-CM, CPT and HCPCS Level II with correct modifier application, NCCI edit and MUE compliance, and place-of-service accuracy across professional and facility claims.
Charge capture & claim scrubbing
Charge reconciliation against the encounter and chargemaster, then multi-pass scrubbing against payer-specific and clearinghouse edits so 837P/837I claims transmit clean on first submission.
Denial management & appeals
Root-cause classification of CARC/RARC denials, categorical trending, corrected-claim and multi-level appeal workflows, and upstream fixes that convert one-time recoveries into prevented denials.
A/R follow-up & payment posting
Aging-bucket-prioritized A/R work, 835/ERA auto-posting with variance detection, contractual-adjustment validation and underpayment recovery against negotiated fee schedules.
Analytics, credentialing & compliance
KPI dashboards across the cycle, payer enrollment and credentialing support, and documented, audit-ready workflows aligned to each payer's policies and the client's governance requirements.
How we work
A yield-first path, engineered to prevent denials.
Baseline the cycle and quantify leakage
We audit the full revenue cycle — clean-claim rate, first-pass resolution, denial categories, days in A/R, net collection rate and aged-trial-balance composition — and map where charges, documentation or payer edits are leaking reimbursement.
Fix the front end first
Registration accuracy, real-time eligibility, coordination-of-benefits sequencing and prior authorization are tightened up front, because most denials are engineered — or prevented — before a claim is ever coded.
Code to the documentation
Certified coders and CDI reconcile ICD-10-CM, CPT and HCPCS to the clinical record with correct modifiers and NCCI/MUE compliance, so claims reflect the care delivered and withstand payer and audit scrutiny.
Submit clean, then work every denial to root cause
Claims are scrubbed against payer-specific edits before transmission; denials are classified by CARC/RARC, appealed within timely-filing windows and traced to the upstream defect so the same denial does not recur.
Recover A/R and report what compounds
Aging-prioritized follow-up, ERA variance detection and underpayment recovery drive balances to resolution — reported through dashboards that tie clean-claim rate, denial rate, A/R days and net collections to cash.
Clean claims
Higher first-pass clean-claim and first-pass resolution rates
A/R days
Fewer days in accounts receivable and less aged balance
Denials
Lower denial and rework rates through root-cause prevention
Net yield
Improved net collection rate against contracted fee schedules
The levers we optimize for every revenue-cycle engagement. Actual results depend on your specialty, payer mix, contracts, documentation quality and starting point — we baseline your KPIs and report against them from day one.
Why Telemedia Solutions
Coding is clinical. Collections are the proof.
Clinical-financial fluency
We speak the language of both the chart and the claim — CDI, ICD-10-CM, CPT, DRG/APC and payer policy — so coding reflects the acuity documented and reimbursement matches the care delivered.
Denial prevention over denial chasing
Recovering a denial is expensive; preventing it is margin. We trace every CARC/RARC to its upstream defect and fix the process, so first-pass yield rises instead of the rework queue.
Yield metrics, not activity
We manage to clean-claim rate, first-pass resolution, days in A/R and net collection rate — the KPIs that move cash — not touches logged or claims merely submitted.
Interoperable with your systems
We work inside your EHR and practice-management platform and across standard EDI transactions, so the cycle stays connected to your clinicians, your clearinghouse and your payers.
Audit-ready by design
Documented coding rationale, modifier justification, medical-necessity support and clean attribution mean claims — and the revenue behind them — hold up under payer audit and internal review.
Frequently asked questions
What revenue and compliance leaders ask first.
Which parts of the revenue cycle do you manage?
The full cycle or discrete stages, depending on your needs — front-end registration, eligibility and benefit verification, prior authorization; mid-cycle clinical documentation integrity, certified coding and charge capture; and back-end claim submission, denial management, appeals, payment posting and A/R follow-up. We can operate the entire cycle or augment a specific gap such as coding, denials or aged A/R.
What coding credentials and specialties do you cover?
Coding is performed by AAPC/AHIMA-credentialed coders across ICD-10-CM, CPT and HCPCS Level II, with correct modifier usage and NCCI/MUE compliance for both professional (837P) and facility (837I) claims. We support multi-specialty professional billing as well as facility coding tied to DRG and APC assignment, and we align to each payer's policies and edits.
How do you reduce denials rather than just resubmit them?
Every denial is classified by CARC/RARC, trended by category and root cause, and traced to the upstream defect — a registration error, missing authorization, documentation gap or coding edit. We appeal within timely-filing limits to recover the dollars, then fix the process that caused the denial so first-pass clean-claim and resolution rates improve over time.
Do you work inside our EHR and practice-management system?
Yes. We operate within your existing EHR and practice-management or billing platform and across standard EDI transactions (270/271, 276/277, 278, 837 and 835), rather than forcing a rip-and-replace. Access, roles and data handling are configured to your security and governance requirements.
How do you handle protected health information?
PHI is handled under the client's contracts, policies and applicable law. When legally required, the parties execute the appropriate Business Associate Agreement, and we implement role-based access, least-necessary data handling and documented workflows defined with the client. We operate within your compliance framework and do not replace your compliance function.
How do you measure success?
Against revenue-cycle KPIs: first-pass clean-claim rate, first-pass resolution rate, denial rate, days in A/R, aged-trial-balance composition, net collection rate and underpayment recovery. We baseline these during discovery and report against agreed targets continuously.
How quickly will we see results?
Front-end and denial-workflow fixes can move first-pass and A/R metrics within weeks, while documentation and coding improvements compound over subsequent cycles as prevented denials accumulate. We sequence the work so early recoveries fund the durable process improvements, and we report short-term and compounding metrics side by side.
Start recovering revenue
Get a revenue-cycle assessment built around your KPIs.
Tell us about your specialty, payer mix, systems and where reimbursement is stalling. We'll review your clean-claim rate, denial categories, days in A/R and net collection rate, then return a prioritized plan covering front-end accuracy, coding integrity, denial prevention and A/R recovery.
No obligation — just a clear, yield-first read on where your next dollar of recoverable revenue is hiding.
Telemedia Solutions
Technology. AI. Growth. Compliance.
Verify. Code. Collect. Prevent.