Revenue Cycle Management
At Pro1 Health, we deliver comprehensive Revenue Cycle Management solutions tailored to physician practices, hospitals, and billing companies. Our RCM services drive timely reimbursements, minimize denials, and provide complete financial transparency, enabling healthcare providers to focus on delivering quality patient care while we manage the complexities of the revenue cycle.
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Results-Driven Medical Billing Solutions
<30
Days in AR
10-15%
Revenue Increase
0%
First Pass Ratio
0%
Collection Ratios
0%
Clean Claims Rate
Patient Registration and Demographics Entry
Patient scheduling and registration can be time-consuming and highly manual. Our experienced team manages the entire process, helping reduce no-shows and improve patient engagement to ensure the best possible outcomes for both providers and patients. We collect, verify, and accurately enter patient information into your practice management system to build clean claims from day one.
We collect, verify, and enter accurate patient information into your practice management system to build a clean claim from day one.
Our Services
Capturing patient demographics such as address, SSN, date of birth, and emergency contact details.- Collecting employer and insurance information
- Real-time integration with your EHR or PMS
Benefits
- Reduces eligibility and demographic-related denials
- Builds a reliable and comprehensive patient database
- Ensures cleaner and more accurate claim submissions
Insurance Eligibility & Benefits Verification
We verify insurance coverage and benefit details prior to the date of service, enabling you to set accurate patient expectations and prevent costly claim rejections. Our team brings extensive experience in patient eligibility verification and delivers quick turnaround times to support seamless billing operations.
Our team has rich experience in handling patient eligibility verification and will provide quick turnaround.
Our Eligibility
- Real-time insurance eligibility verification
- Pre-authorization and referral acquisition
- Verification through payer portals, phone, and fax
Benefits
- Improves first-pass claim acceptance rates
- Enhances upfront patient collections
- Reduces out-of-network billing surprises
Medical Coding
Our team of AAPC- and AHIMA-certified coders ensures accurate diagnosis and procedure code selection in compliance with CMS guidelines and payer-specific requirements. Pro1 Health’s coding and auditing services enhance revenue cycle performance by improving productivity and maintaining high-quality standards.
Pro1 Health coding and auditing services makes your revenue cycle improve productivity and quality.
Coding Strengths
- Specialty-based coding, including Cardiology, Orthopedics, Radiology, DME, and more
- Support for HCC, CPT, HCPCS, and ICD-10 coding
- Daily audits and quality assurance checkpoints
Benefits
- Audit-ready documentation
- Accurate risk scoring and optimized reimbursement
- Reduced coding-related denials
Charge Entry & Superbill Analysis
We meticulously translate clinical documentation into accurate, billable entries within your billing system to ensure compliance and optimal reimbursement.
Key Activities
- Compatibility checks between diagnosis and procedure codes
- Appropriate modifier application
- Fee schedule mapping
- Charge batch balancing
Result
- Accurate claim values
- Alignment with payer-specific billing guidelines
Claims Submission & Clearinghouse Management
We ensure the timely electronic submission of claims using ANSI 837 formats through secure clearinghouses or direct payer portals, maintaining accuracy and compliance at every stage.
Our Services
- Review of rejections and prompt re-submission
- Claims tracking and validation
- Real-time NEA number generation for document attachments
Outcome
- Faster reimbursements
- Reduced claims rejected
Payment Posting
We manage both insurance and patient payments, reconciling them with detailed claim-level data within your PMS or EHR to ensure financial accuracy and transparency.
Scope
- ERA and manual EOB posting
- Co-pay and self-pay application
- Adjustment and write-off processing
Why It Matters
- Maintains an accurate accounts ledger
- Enables real-time accounts receivable analysis
- Identifies underpayments and payment discrepancies
Accounts Receivable (AR) Follow-up
Our AR specialists proactively track, analyze, and follow up on aging claims to reduce Days in AR and accelerate cash flow.
We Offer
- Aged claims reporting from your PMS
- Follow-up on denied and pending claims
- Trend analysis to identify payer-specific issues
Benefits
- Higher collection rates
- Fewer claims lost due to aging
- Proactive issue resolution
Denial Management & Appeals
We systematically classify denials, identify root causes, and implement corrective actions to prevent recurrence. Our structured appeals process is designed to maximize recovery and strengthen overall revenue performance.
Typical Denial Categories Managed
- Authorization-related issues
- Medical necessity denials
- Coding errors or missing modifiers
- Timely filing and eligibility-related denials
Deliverables
- Appeal letters with supporting documentation
- Re-submission tracking and follow-up
- Monthly denial analysis and performance reports
Credentialing Services
We manage new provider enrollments and ongoing payer credentialing to help you maintain active network participation and accelerate reimbursement timelines.
Our Services
- CAQH setup and profile updates
- Payer-specific application submission
- Continuous follow-up through approval
Results
- Reduced credentialing-related payment delays
- Accurate and compliant billing setup for new providers
Why Choose Pro1 for Medical RCM?
Our Value-Added Services
Let us become your trusted RCM partner :Partner with Pro1 Health as your trusted RCM expert. We go beyond claim processing to optimize your revenue cycle, enhance efficiency, and safeguard your profitability.
Our Medical Billing Process
We take a systematic approach to filing your claims. Our medical billing process is designed to maximize reimbursements on the first submission. We work closely with healthcare providers to ensure accurate, compliant, and timely claim processing.
1. Requirement Analysis
We begin by assessing your practice’s needs, goals, and existing billing workflow to develop a tailored strategy.
2. Patient Registration & Verification
We collect all relevant patient information and verify their insurance coverage to prevent eligibility-related denials.
3. Coding
Our certified coders assign accurate CPT, ICD-10, and HCPCS codes to medical services and procedures in compliance with payer guidelines.
4. Claim Submission
Claims are submitted electronically to the appropriate insurance carriers to ensure timely processing.
5. Payment Posting
Once claims are processed, we accurately post payments received from payers and patients into your system.
6. Follow Up
We monitor outstanding claims, follow up on pending or denied claims, and provide detailed financial reports to ensure consistent cash flow.
24/7 Support Across All Specialties
Get answers to your questions! At Pro1 Health, we provide 24/7 dedicated customer support across all our services. Our experienced team has the knowledge and expertise to address medical billing, coding, and related issues across all specialties with accuracy and efficiency.
Our Expertise in PMS Software
With extensive hands-on experience, we seamlessly integrate with leading practice management systems to streamline your revenue cycle and improve operational efficiency. Our billing team is proficient across a wide range of PMS and medical billing platforms, ensuring accuracy, compliance, and smooth system alignment. We quickly adapt to client-specific workflows, enabling seamless integration without disrupting your existing operations.
Streamline Operations, Accelerate Collections.
Partner with us for end-to-end RCM solutions that strengthen cash flow and empower you to focus on delivering exceptional patient care.