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.
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.
We tie every patient access registration directly through to final zero balance through nine connected stages. Eligibility, authorization, charge capture, coding, claims, denials, AR, underpayment recovery, and patient billing are handled by one team accountable for outcomes.
Monthly CFO dashboards cover Net Patient Revenue lift, days in AR by payer, denial rate by department, underpayment recovery, and total revenue cycle cost. A named senior director is assigned to your hospital, with quarterly board-ready performance reviews delivered as standard.
Every hospital account is led by a senior director with more than 10 years of hospital revenue cycle leadership and HFMA-CRCR or HFMA-CHFP credentials. You receive direct phone access, monthly CFO calls, and one executive accountable for your account.
Pricing is tied to Net Patient Revenue managed and agreed KPI performance guarantees. There are no hidden setup fees or contracts extending beyond 24 months. Our performance-linked structure means we share accountability for denial recovery and underpayment identification.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Optimized by Seraphinite Accelerator