Revenue Discovery
Audit and Revenue Assessment
We review your current billing workflow, denial patterns, aging accounts receivable, missed charges and other potential revenue gaps before recommending the right service scope.
Most billing companies charge 6% to 9% of collections, lock you into 24-month contracts, and route your claims through generic call centers that don’t know your specialty. We do it differently. One O Seven RCM delivers full-service private practice billing services at 3.99% of net collections. AAPC-certified coders. 99% first-pass claim acceptance. 24-hour claim submission. No setup fees. No long-term contracts. Built around what your practice actually wants from billing.
Here’s the thing. Your front desk shouldn’t be wrestling with denials at month-end. Your providers shouldn’t be waiting 60 days for claims to clear. Your practice shouldn’t pay enterprise rates for generic billing. We fix what’s broken in your revenue cycle without locking you into anything. Specialty-trained coders. HIPAA-compliant infrastructure. Transparent flat-rate pricing.
We review your current billing workflow, denial patterns, aging accounts receivable, missed charges and other potential revenue gaps before recommending the right service scope.
Our onboarding team maps your EHR, payer workflows and internal responsibilities. Secure access, applicable BAA requirements and escalation pathways are completed before live work begins.
The assigned team manages claim preparation, submission, payment posting, denial follow-up and accounts-receivable activity through documented correction and appeal workflows.
Customized reporting can track claim acceptance, collections, denial trends, AR aging, payer performance and procedure-level revenue opportunities.
One O Seven RCM delivers ten core revenue cycle services as part of every standard private practice billing engagement at 3.99% of net collections. Nothing is tiered. Nothing is withheld at the base rate. Every service below is handled by AAPC-certified coders and billing specialists with hands-on experience across 75 plus medical specialties, from solo family practices to multi-provider mental health groups.
We verify every patient’s active coverage, in-network status, deductible balance, coinsurance and copay responsibility before the date of service through payer portals and available EDI connections. Practices receive clear eligibility information before the visit.
Every claim passes through a multi-point review for CPT and ICD-10-CM codes, modifiers, place of service, NPI information and fee-schedule alignment. This process helps identify common submission errors before claims reach the payer.
We submit claims electronically to Medicare, Medicaid and commercial payers after receiving complete charge and documentation information. Claim status is monitored from submission through payer adjudication so unresolved claims can be addressed promptly.
Rejections and denials are categorized separately and reviewed against payer requirements, documentation and claim history. Corrected claims and appeals follow the appropriate payer pathway while recurring patterns are tracked for prevention.
We manage prior authorization workflows for payer-required services, including request submission, documentation coordination and status follow-up. Retroactive authorization requests are handled where the payer and plan permit them.
Coding workflows support CPT, ICD-10-CM and HCPCS reporting based on provider documentation and applicable payer requirements. Complex code selection, modifier use and E/M questions are reviewed by professionals holding credentials appropriate to the assigned scope.
Electronic remittance advice and payer EOB information are posted and matched to corresponding claims. Contractual adjustments, denials and patient responsibility are recorded accurately while potential underpayments are flagged for further review.
Outstanding claims are prioritized according to age, balance, payer response and filing deadlines. Follow-up attempts, payer findings and required next steps are documented so unresolved balances continue moving toward resolution.
Patient statements are prepared in readable formats and outstanding balances are followed through professional, non-aggressive communication. Available payment options and account information are explained clearly while complex issues follow an escalation pathway.
Monthly reporting can include claim acceptance, denial trends, collection performance, AR aging, payer mix and procedure-level revenue insights. Reports are aligned with the agreed service scope and the practice’s operational priorities.
We verify every patient's active coverage, in-network status, deductible balance, and co-insurance responsibility before the date of service through direct payer portals and EDI connections. Practices receive a pre-visit eligibility report so the front desk knows exactly what to collect.
Every claim passes through a multi-point scrubbing process that checks CPT codes, ICD-10-CM codes, modifier accuracy, place of service codes, NPI numbers, and fee schedule alignment against CMS-1500 form requirements. That's what produces the 99% first-pass acceptance rate.
We submit all claims electronically within 24 hours of charge entry to Medicare, Medicaid, and major commercial insurers. Every claim is tracked from submission through adjudication. Nothing sits in a queue unmonitored. If a claim doesn't move, we move it.
We separate rejections from denials. Both get a root cause analysis within 48 hours. The corrected claim or formal appeal goes back with payer-specific documentation, not a generic resubmission. We track denial patterns by payer and code to prevent recurrence.
We handle prior authorization and retro authorization for all applicable procedures, including submitting auth requests, following up with payers on pending decisions, and tracking expiration dates so authorizations don't lapse mid-treatment. Medical necessity documentation is coordinated with the clinical team.
All coding is performed by AAPC-certified specialists working across CPT, ICD-10-CM, and HCPCS Level II code sets. Coders are assigned by specialty. E/M code selection runs from 99202 through 99215 based on documented complexity. Undercoded visits are corrected before submission.
We post Electronic Remittance Advice (ERA) and paper EOBs within 24 hours of receipt. Every payment is matched to its original claim. Every contractual adjustment is verified against payer contracts. When a payer pays less than the contracted rate, we flag and appeal.
We follow up on all outstanding claims at 30, 60, and 90-day intervals. No claim is written off without a documented follow-up attempt and explicit client notification. AR aging reports are included in every monthly dashboard. Target for clean claims: AR days under 30.
We generate and send patient statements in plain, readable formats. Follow-up on outstanding balances uses soft collections: professional, non-aggressive contact that gives patients a clear path to pay. Online payment options are included. Patient-friendly process. Recovery without relationship damage.
Every client receives a monthly KPI dashboard customized to their specialty, tracking claim acceptance rate, denial rate by payer, collection rate, AR days by aging bucket, revenue by procedure code, and payer mix analysis. Fee schedule optimization opportunities flagged proactively.
One O Seven RCM integrates directly with the EHR or practice management software your practice already uses. No software migration, no hardware purchase, no system replacement. Integration is completed during onboarding with zero disruption to daily operations, and all data transfers run through HIPAA-compliant protocols.
Billing requirements change significantly from one specialty to the next. That’s why One O Seven RCM assigns coders with specialty-specific certification and experience to each practice, not generalists who split their time across unrelated disciplines. Specialty medical billing produces higher first-pass acceptance rates because the coder already knows the codes, the modifiers, and the payer rules that specific specialty deals with every day. Billing services for physicians only work when the billing team speaks the same clinical language as the provider.
Free 90-day claims audit. AAPC-certified coders. No setup fees. No long-term contracts. See exactly what affordable private practice billing looks like.
One O Seven RCM executes a Business Associate Agreement (BAA) with every client before billing operations begin. All patient health information transmits using encrypted protocols. We don’t share data without authorization. Role-based access controls apply to all billing systems. Annual HIPAA training applies to all staff.
Our coding practices comply with OIG guidelines for medical billing. AAPC-certified coders follow AMA CPT coding standards. Internal audits prevent upcoding and unbundling violations. You’re protected from billing-related compliance risk. We handle payer audit responses and coding dispute documentation.
From billing to credentialing to patient acquisition, One O Seven RCM drives every stage of your growth.
Optimized by Seraphinite Accelerator