End-to-End Hospital Revenue Cycle Management Services

Hospital Revenue Cycle Management That Recovers Net Patient Revenue Leakage for Health Systems and Community Hospitals

Most hospitals lose 8% to 11% of Net Patient Revenue annually to denied claims, underpayments, charity write-offs, and bad debt. Most outsourcing partners deliver marginal improvement at best. We’re One O Seven RCM, an HFMA-aligned hospital revenue cycle management company that recovers measurable Net Patient Revenue through end-to-end Access-to-Zero-Balance operations. CFO-level reporting. Named senior leadership accountability. KPI-tied performance guarantees. Acute care, community hospital, critical access, and behavioral health hospital coverage under one engagement structure consistently delivered.

Here’s what hospital RCM looks like when run by people who’ve operated inside hospital cash flow realities. Our Access-to-Zero-Balance framework ties every patient access registration directly through to final zero balance. Patient access, eligibility, charge capture, coding, claims, denials, AR follow-up, underpayment recovery, and patient billing handled by HFMA-aligned specialists who know your hospital payer mix.

What Makes Us Different at the Hospital Scale

What Makes One O Seven RCM the Right Hospital Revenue Cycle Management Partner for Health Systems and Acute Care Hospitals

Health systems choose One O Seven RCM because we’re built for hospital revenue cycle complexity, not adapted from clinic billing operations. HFMA-aligned senior leadership. CFO-level reporting cadence. KPI-tied pricing structure. The Access-to-Zero-Balance framework that ties every patient access registration directly through to final zero balance. Hospital revenue cycle management is what we do.

Access-to-Zero-Balance Framework

We tie every patient access registration directly through to final zero balance through 9 connected stages. Eligibility, authorization, charge capture, coding, claims, denials, AR, underpayment recovery, and patient billing handled by one team accountable for outcomes.

CFO-Level Reporting and Accountability

Monthly CFO dashboards covering Net Patient Revenue lift, days in AR by payer, denial rate by department, underpayment recovery, and total cost of revenue cycle. Named senior director assigned to your hospital. Quarterly board-ready performance reviews delivered standard.

HFMA-Aligned Senior Leadership

Every hospital account led by a senior director with 10+ years of hospital revenue cycle leadership. HFMA-CRCR or HFMA-CHFP credentialed. Direct phone access. Monthly CFO calls. One executive accountable for your account, not a rotating account team.

Transparent KPI-Tied Pricing

Pricing tied to Net Patient Revenue managed plus KPI performance guarantees. No hidden setup fees. No long-term contracts beyond 24 months. Performance-tied fee structure means we share the risk of denial recovery and underpayment identification with you.

See How Our Hospital RCM Methodology Compares to Your Current Vendor in a Free CFO-Level Diagnostic

End-to-End Hospital RCM Coverage

Complete Hospital Revenue Cycle Management Services Under One Engagement

Most hospitals fragment their revenue cycle across 5 to 8 vendors covering patient access, coding, claims, denials, AR, and patient collections separately. Each handoff loses revenue. We handle every stage of the hospital revenue cycle under one engagement, one senior director, and one transparent pricing structure tied to Net Patient Revenue managed and KPI performance guarantees consistently.

Patient Access & Pre-Registration

Pre-registration, eligibility verification, demographic accuracy, and point-of-service collection coordination 48 to 72 hours before scheduled encounters. Real-time benefits validation. Authorization tracking. Patient financial counseling for high-deductible plans. Front-end accuracy reduces back-end denial volume substantially across departments.

Eligibility Verification & Prior Authorization

Real-time eligibility verification across all major payer portals. Prior authorization handling for inpatient admissions, surgical procedures, and high-dollar diagnostics. Authorization expiration tracking. Medicare Advantage authorization burden managed proactively. Coverage validation posted directly to your EHR system before patient arrival.

Charge Capture & Chargemaster Maintenance

Daily charge reconciliation against scheduled encounters. Chargemaster (CDM) maintenance with quarterly pricing reviews. Late charge identification and capture. Charge integrity audits. Lost charge recovery typically yields 1 to 3% of Net Patient Revenue most hospitals leave behind unrecovered.

Hospital Coding (ICD-10, CPT, DRG)

Inpatient DRG coding by AHIMA-credentialed coders. Outpatient CPT and ICD-10 coding. CDI (Clinical Documentation Improvement) queries to physicians. CC/MCC capture optimization. Quarterly coding audits against OIG Work Plan items. NCCI edits applied before claim submission every time.

Claims Management & Submission

UB-04 institutional claims and CMS-1500 professional claims handled. Clearinghouse integration with Availity, Change Healthcare, and Waystar. Payer-specific edits applied before submission. Claim status tracking through final adjudication. Acknowledgment reconciliation handles every claim end-to-end every time.

Denial Management & Appeals

Every denial worked within 48 hours by senior denial specialists. Root cause coded for prevention reporting. Payer-specific appeals letters drafted with supporting clinical documentation. Recovery rates tracked monthly. Denial-prevention recommendations delivered alongside performance reports each quarter consistently.

AR Follow-Up & Insurance Collections

Aged claim work prioritized by dollar value, payer, and timely filing window. Payer follow-up at 30, 45, 60, and 90-day intervals. Days in AR by payer reported weekly. Insurance collections optimized before patient billing escalation begins.

Patient Financial Services & Self-Pay Collections

HIPAA-compliant patient statements via mail, email, and SMS. Payment plan setup. Charity care screening per IRS 501(r) requirements. Bad debt placement coordination. Self-pay balance follow-up handled with patient-relationship-protecting language. TCPA-compliant outbound communication every single time.

See Exactly What's Included in Our Hospital RCM Service With Full Transparency on Every Workstream

Built for Your Hospital Type

Hospital Revenue Cycle Management Services for Every Hospital Type and Care Setting

Different hospital types have fundamentally different revenue cycle realities. Critical access hospitals operate on cost-based Medicare reimbursement. Teaching hospitals carry GME billing complexity layered on standard inpatient operations. Behavioral health hospitals navigate parity rule denials. Community hospitals balance commercial payer mix against high uninsured volume. Our hospital RCM teams have deep operational experience inside each hospital category, not generic billers learning hospital types on your account.

Acute Care Hospital RCM

Acute care hospital revenue cycle management handles the broadest service mix in healthcare. Inpatient DRG billing, outpatient CPT billing, observation status coding, surgical billing, ED billing, and ancillary services billing all need integration. Our acute care team handles MS-DRG and APR-DRG optimization, CC/MCC capture through Clinical Documentation Improvement, observation-versus-inpatient status determination, and the complex outpatient prospective payment system (OPPS) that drives most acute care revenue. Specialty knowledge means we manage acute care revenue cycle the way acute care hospitals actually operate every single day across departments.

Community Hospital RCM

Community hospital billing operates on tighter margins than larger health systems. Commercial payer mix fluctuates regionally. Self-pay and uninsured volume often exceeds 15% of total encounters. Medicaid managed care complexity drains AR. Our community hospital team handles commercial payer contract performance audit, Medicaid managed care follow-up specific to your state, IRS 501(r) charity care compliance, and the bad debt placement coordination that community hospitals depend on for cash flow stability. We protect community hospitals from the underpayment patterns that crush mid-margin acute care operations year-round across every payer category.

Critical Access Hospital (CAH) RCM

Critical access hospitals operate under fundamentally different Medicare reimbursement than other hospital types. Cost-based reimbursement at 101% of allowable costs requires precise cost report preparation. Method II billing election for CAH-employed physicians changes the billing structure. Medicare bad debt reimbursement is recoverable but most CAHs leave money on the table. Our critical access team handles CAH cost report preparation support, swing bed billing, CAH-specific Medicare fee schedule application, and the rural health clinic billing many CAHs operate alongside their inpatient operations year-round. Most CAH billing companies don’t understand cost-based reimbursement adequately for compliance.

Teaching Hospital RCM

Teaching hospital billing combines standard inpatient and outpatient revenue cycle with the unique requirements of academic medical centers. Graduate Medical Education (GME) billing, Indirect Medical Education (IME) adjustments, Disproportionate Share Hospital (DSH) payments, 340B drug pricing program compliance, and clinical research billing each carry separate compliance frameworks. Our teaching hospital team handles GME and IME reimbursement optimization, DSH payment audit, 340B program compliance, and the Medicare Advantage prior authorization burden that crushes academic medical center cash flow without dedicated specialty expertise. Teaching hospital revenue cycle requires deeper regulatory knowledge than standard acute care.

Behavioral Health Hospital RCM

Behavioral health hospital billing operates under stricter payer rules than most hospital types. Mental health parity rules, residential treatment billing, partial hospitalization program (PHP) billing, intensive outpatient program (IOP) billing, and authorization-heavy inpatient psychiatric admissions all need specialty knowledge. Our behavioral health hospital team handles psychiatric inpatient billing, addiction recovery facility billing, dual-diagnosis billing complexity, and the parity-violation denial appeals that are unique to behavioral health revenue cycle. We protect behavioral health hospitals from authorization expiration and parity-related denials that drain cash flow when handled by generic hospital RCM teams.

Children's Hospital RCM

Pediatric inpatient and outpatient

Rehabilitation Hospital RCM

IRF-PAI and FIM coding

LTACH RCM

Long-term acute care billing

Surgical Hospital RCM

Specialty surgical billing

Hospital Pharmacy RCM

340B and inpatient pharmacy

Psychiatric Hospital RCM

Inpatient psychiatric and PHP

Specialty Hospital RCM

Orthopedic and cardiac

Hospital-Owned Physician Groups

Get a Custom Quote Built for Your Specialty's Payer Mix and Small Practice Workflow

The Hospital RCM Operational Difference

Why Health Systems and Acute Care Hospitals Choose One O Seven RCM Over Tier-1 Hospital RCM Vendors

Most hospital RCM vendors will tell you they handle hospital revenue cycle complexity. Few will show you exactly what makes their operational depth different from each other vendor in your RFP stack. Here’s what running hospital revenue cycle management looks like when it’s run by people who’ve operated inside hospital cash flow realities at the CFO level for years.

HFMA-Credentialed Senior Leadership

Every hospital account led by a senior director with HFMA-CRCR or HFMA-CHFP credential plus 10+ years hospital revenue cycle experience. Direct CFO access. Monthly review calls. Single executive accountability across the engagement.

Payer Contract Audit Built In

Most RCM vendors don’t audit payer contract performance. We do quarterly payer contract audits identifying underpayments against negotiated rates. Recovery typically delivers 2 to 4% of Net Patient Revenue annually that competitors leave behind.

DRG/CDI Optimization Native

AHIMA-credentialed coders handle DRG assignment with CC/MCC capture optimization. Clinical Documentation Improvement queries to physicians built into workflow. Most hospitals gain 1.5 to 3% Net Patient Revenue lift through proper DRG and CDI execution.

Daily and Monthly CFO Dashboards

Daily operational dashboard for revenue cycle staff. Monthly CFO dashboard covering NPR, days in AR by payer, denial rate by department, and total cost of revenue cycle. Quarterly board-ready performance reviews delivered standard.

EHR-Native Integration

Native integration with Epic, Cerner / Oracle Health, Meditech, AllScripts, and other major hospital EHRs. No data export friction. Real-time charge posting. Real-time AR visibility. Real-time denial routing without manual data movement workflows.

90-Day Performance Baseline Promise

Within 90 days of go-live, we deliver baseline performance benchmarks against KPI guarantees. Most RCM vendors take 12 to 18 months to show measurable performance. We commit to baseline visibility within the first quarter.

Compare Our Hospital RCM Operational Depth to Your Current Vendor or Internal Team in a CFO Diagnostic

How We Run Hospital Revenue Cycle Management

Our 9-Stage Access-to-Zero-Balance Process for Hospital Revenue Cycle Management

Every hospital RCM engagement follows the same 9-stage Access-to-Zero-Balance process from patient access registration to final zero balance. CFOs always know what’s happening at every stage. Daily operational visibility. Monthly executive reporting. No black-box revenue cycle. No mystery about where Net Patient Revenue is moving through the cycle right now today.

Patient Access & Pre-Registration

Pre-registration begins 48 to 72 hours before scheduled encounters. Demographic accuracy verified. Insurance information validated. Point-of-service collection coordinated. Patient financial counseling scheduled for high-deductible plans. Front-end accuracy reduces back-end denial volume substantially across every encounter type your hospital handles.

Eligibility & Prior Authorization

Real-time eligibility verification across all major payer portals. Prior authorization handling for inpatient admissions, surgical procedures, and high-dollar diagnostics. Medicare Advantage authorization burden managed proactively. Authorization expiration tracking. Coverage validation posted directly to your EHR before patient arrival every encounter.

Charge Capture & Chargemaster Integrity

Daily charge reconciliation against scheduled encounters. Chargemaster (CDM) maintenance with quarterly pricing reviews. Late charge identification and capture. Charge integrity audits identify lost charges. Lost charge recovery typically yields 1 to 3% of Net Patient Revenue most hospitals leave behind unrecovered.

Hospital Coding (DRG, CPT, ICD-10)

AHIMA-credentialed coders assign inpatient DRG, outpatient CPT, and ICD-10 codes. CDI queries to physicians built into workflow. CC/MCC capture optimization. NCCI edits applied before claim submission. Quarterly coding audits against OIG Work Plan items prevent compliance exposure.

Claims Submission & Scrubbing

UB-04 institutional claims and CMS-1500 professional claims submitted electronically through clearinghouse integration. Payer-specific edits applied automatically before submission. Claim scrubbing catches missing modifiers, wrong place of service, and CCI conflicts. Clearinghouse acknowledgment tracking handles every claim end-to-end consistently.

Denial Management & Appeals

AR Follow-Up & Insurance Collections

Underpayment Recovery & Payer Contract Audit

Quarterly payer contract audits identify underpayments against negotiated rates. Underpaid claim data extracted and recovered systematically. Contract performance tracked by payer. Most hospitals carry 2 to 4% of Net Patient Revenue in undetected underpayments that we identify and recover monthly.

Patient Financial Services & Zero Balance

HIPAA-compliant patient statements via mail, email, and SMS channels. Payment plan setup. Charity care screening per IRS 501(r) requirements. Bad debt placement coordination. Self-pay balance follow-up. Account management through final zero balance posted with full reconciliation completed.

Walk Through Our Access-to-Zero-Balance Methodology With a Senior Hospital RCM Director in 45 Minutes

Compliance and Security at Hospital Scale

HIPAA-Compliant Hospital Revenue Cycle Management Built Around BAA, SOC 2, OIG, and Hospital-Specific Regulatory Standards

Hospital compliance is fundamentally deeper than clinic compliance. CMS Conditions of Participation, OIG Work Plan items affecting hospital billing, 340B drug pricing program, EMTALA obligations, and IRS 501(r) charity care requirements all carry separate frameworks. We treat compliance as foundation, not checkbox. Operational practices we run daily, audit quarterly, and improve continuously across every hospital account managed.

HIPAA-Native Operations

Every team member completes HIPAA Privacy Rule and Security Rule training before account access. Annual recertification mandatory across the entire team. Encrypted PHI access using TLS 1.2 or higher. Continuous audit logging on every system. Incident response procedures tested quarterly against breach scenarios. We follow current HHS guidance on PHI handling for hospital revenue cycle operations.

Business Associate Agreements

BAA signed before any hospital data access begins. Non-negotiable across every engagement regardless of hospital size or service scope. Our BAA includes all required HHS provisions: permitted uses, safeguards, breach notification, subcontractor accountability, and termination rights. We provide a BAA template review session with hospital legal teams before contract signing for compliance clarity always.

OIG Work Plan-Aligned Coding & MAC Audit Defense

Coding aligned with current OIG Work Plan items affecting hospital billing. Quarterly internal coding audits identify upcoding, undercoding, and DRG miscoding risks proactively. We follow Office of Inspector General guidance, Stark Law boundaries, and Anti-Kickback statutes. MAC audit defense documentation maintained for every claim. Hospitals facing RAC, MAC, or OIG audits get full chart-and-claim audit support immediately.

SOC 2 Type II Security

Hospital account hosting in SOC 2 Type II audited environment. Annual security audits performed by accredited third-party auditors. Continuous monitoring of access controls, change management, system operations, and risk mitigation. Encryption at rest and in transit. Multi-factor authentication mandatory for every team member with PHI access. Security incident response within 4-hour service level agreement.

Hospital-Specific Regulatory Compliance

CMS Conditions of Participation alignment built into operational workflows. 340B drug pricing program compliance for participating hospitals. EMTALA obligation tracking for emergency department billing. IRS 501(r) charity care compliance for tax-exempt hospitals. Disproportionate Share Hospital (DSH) payment audit. Provider-Based Designation rules followed for hospital-owned outpatient operations. Hospital regulatory complexity handled natively across every engagement.

Get a Free Hospital RCM Compliance Review Covering BAA, SOC 2, OIG, and Hospital-Specific Frameworks

Common Hospital RCM Questions

Frequently Asked Questions

Still have specific questions about your hospital's revenue cycle situation?

Talk to a senior hospital RCM director for a free CFO-level diagnostic. We’ll review your current revenue cycle KPIs, denial patterns, and answer every specific question you have today.

What is hospital revenue cycle management?

Hospital revenue cycle management is the end-to-end financial process from patient access through final account zero balance. Includes pre-registration, eligibility, prior authorization, charge capture, hospital coding (DRG, CPT, ICD-10), claims submission, denial management, AR follow-up, underpayment recovery, and patient financial services. Hospital RCM is more complex than clinic RCM because of payer contract complexity, compliance frameworks, and chargemaster integrity requirements at hospital scale.

What does hospital revenue cycle management include?

Comprehensive hospital revenue cycle management includes 9 connected workstreams. Patient access and pre-registration. Eligibility verification and prior authorization. Charge capture and chargemaster maintenance. Hospital coding by AHIMA-credentialed coders. Claims submission with payer-specific scrubbing. Denial management and appeals. AR follow-up and insurance collections. Underpayment recovery and payer contract audit. Patient financial services and self-pay collections through final zero balance posted with full reconciliation.

How much does hospital revenue cycle management cost?

Hospital revenue cycle management typically costs 3% to 6% of Net Patient Revenue managed at most RCM vendors. Tier-1 vendors charge 5% or more. One O Seven RCM hospital pricing starts at 4.49% of NPR for community hospitals, 3.99% for mid-size hospitals, 3.49% for large hospitals, and custom enterprise pricing for $1B+ NPR health systems. KPI performance guarantees built into every engagement structure.

Should hospitals outsource revenue cycle management?

Outsourcing hospital RCM makes sense for most hospitals when in-house RCM cost plus revenue leakage exceeds 8 to 10% of Net Patient Revenue. In-house RCM at $150M NPR community hospital costs $2.78M to $5.15M annually plus $12M to $16.5M in denial and underpayment leakage. Outsourced RCM at 4.49% costs $6.74M with reduced leakage to $5M to $7M, delivering $3M to $8M annual net improvement.

What's the difference between in-house and outsourced hospital RCM?

In-house hospital revenue cycle management means your hospital hires, trains, and manages 25 to 40 RCM staff plus director-level leadership directly. Outsourced means a specialized RCM company handles the entire revenue cycle. In-house gives direct control but requires high investment in salary, technology, training, and turnover replacement. Outsourced trades direct control for specialty depth, lower total cost, KPI accountability, and elimination of staff management burden.

How long does it take to switch hospital RCM vendors?

Most hospital RCM vendors take 6 to 12 months to migrate a hospital from a previous vendor. One O Seven RCM completes hospital migration in 90 days through our structured Access-to-Zero-Balance migration process. Days 1-14 discovery, days 15-35 payer credentialing and EHR integration, days 36-55 system setup and team onboarding, days 56-75 parallel run testing, days 76-90 full cutover with no Net Patient Revenue disruption.

Are your hospital RCM services HIPAA-compliant?

Yes. Every hospital RCM engagement from One O Seven RCM operates under HIPAA-native compliance from day one. We sign Business Associate Agreements before any data access begins. We host every account in SOC 2 Type II audited environments. Privacy Rule and Security Rule training is mandatory and annually recertified. PHI access encrypted using TLS 1.2 or higher and continuously audited across every workflow.

Do you handle 340B compliance for hospital RCM?

Yes. We handle 340B drug pricing program compliance for participating hospitals including covered entity registration support, eligible patient definition tracking, contract pharmacy oversight, and the duplicate discount prohibition compliance that triggers most 340B audit findings. Our team includes 340B specialists who track HRSA guidance and Apexus updates. Hospital pharmacy revenue cycle for 340B-participating hospitals requires deeper compliance knowledge than non-340B operations consistently.

What hospital types do you handle?

We handle revenue cycle management for every hospital type at scale. Acute care hospitals, community hospitals, critical access hospitals (CAH), teaching hospitals, children’s hospitals, behavioral health hospitals, rehabilitation hospitals, LTACH (long-term acute care hospitals), psychiatric hospitals, surgical hospitals, hospital pharmacies, and hospital-owned physician groups. Each hospital type is staffed by senior teams with vertical-specific operational experience, not generalists learning hospital types on your engagement.

Can you integrate with Epic, Cerner, and Meditech?

Yes. We integrate natively with every major hospital EHR including Epic, Cerner / Oracle Health, Meditech, AllScripts, Athenahealth, eClinicalWorks, NextGen, and Greenway Primesuite. Real-time charge posting. Real-time AR visibility. Real-time denial routing without manual data movement. We also integrate with hospital finance systems (Workday, Oracle Cloud, SAP) and BI platforms for executive reporting flowing directly into your CFO dashboard architecture every cycle.

What's a good days in AR target for hospitals?

A healthy days in AR target for hospitals is 35 to 50 days consistently across payer mix. Industry average runs 50 to 65 days at most hospitals. Anything over 55 days indicates either AR follow-up gaps, denial management weakness, or payer contract issues. One O Seven RCM commits to 20 to 30% days in AR reduction within 12 months of go-live as a baseline KPI performance guarantee.

What's a good denial rate for hospitals?

A healthy denial rate for hospitals is 5 to 9% of total claim volume. Industry average runs 10 to 12% at most hospitals. Anything over 12% indicates either coding gaps, weak claim scrubbing, or front-end patient access failures. One O Seven RCM commits to 25 to 40% denial rate reduction within 12 months of go-live as a baseline KPI performance guarantee in every engagement.

What's the typical Net Patient Revenue lift from outsourced RCM?

Typical Net Patient Revenue lift from outsourced hospital RCM ranges from 5 to 11% in year one and stabilizes at 8 to 12% in year two and beyond. The lift comes from denial reduction (3 to 5%), underpayment recovery (2 to 4%), charge capture improvement (1 to 3%), and faster AR cycle (1 to 2%). One O Seven RCM commits to 5 to 9% NPR lift in year one as a baseline KPI guarantee.

Do you offer KPI-tied performance guarantees?

Yes. Every hospital RCM engagement includes 5 KPI-tied performance guarantees written into the contract. Days in AR reduction by 20 to 30% within 12 months. Denial rate reduction by 25 to 40% within 12 months. First-pass clean claim rate of 95% or higher within 6 months. Underpayment recovery of 2 to 4% of NPR annually. Net Patient Revenue lift of 5 to 9% in year one. KPI accountability built into pricing structure.

How do I get started with One O Seven RCM hospital revenue cycle management?

Start with a free hospital RCM performance diagnostic. We review your current revenue cycle operation, KPI baselines, denial patterns, payer contract performance, AR aging, and migration requirements together. Within two weeks, you receive a CFO-level diagnostic report with KPI benchmark comparison, recovery methodology preview, custom pricing quote, and migration timeline. If you proceed, we sign BAA and begin the 90-day Access-to-Zero-Balance migration immediately.

Ready for Hospital Revenue Cycle Management Built Around CFO-Level Accountability and KPI Guarantees?

Stop letting denied claims and underpayments drain 8 to 11% of Net Patient Revenue every year without recovery. Stop paying tier-1 RCM rates for vendor performance that doesn’t tie to KPI accountability. Stop getting locked into multi-year contracts without performance guarantees you can hold the vendor to. Start working with hospital revenue cycle management led by HFMA-aligned senior directors, AHIMA-credentialed coders, and KPI-tied performance guarantees built into the contract. Access-to-Zero-Balance, all under one engagement, with one senior director accountable for every dollar.