- Full-Cycle Hospital RCM
- Coding & Charge Capture Quality
- AR & Denial Management
Streamlined Revenue Processes for Hospitals
Our Hospital RCM Services
Patient Registration & Insurance Verification
Accurate capture of demographics, insurances, prior-authorizations and eligibility before service.
Charge Capture & Chargemaster Maintenance
Complete capture of all billable services, procedures, supplies, labs and diagnostics, aligned with hospital chargemaster standards.
Coding & Compliance (ICD-10 / CPT / UB-04)
Certified coding, coding audits, modifier application, compliance with payer and regulatory rules.
Claims Submission & Tracking
Electronic & paper claim filing, follow-up, remittance processing, and ERA reconciliation.
Payment Posting & Reconciliation
Accurate posting of payments, adjustments, patient balances, and credit-balance resolution.
Denial Management & Appeals
Investigation, correction, resubmission or appeal of denied or rejected claims to maximize collections.
Accounts Receivable (AR) Management
Proactive follow-up on outstanding claims, aging analysis, patient collections, and AR dashboards.
Credit Balance & Refund Resolution
Identify overpayments or patient credits, correct balances, and manage refunds or write-offs.
Reporting & Analytics / KPI Management
Comprehensive financial reporting, denial trend analysis, claim cycle metrics, cash-flow forecasting and performance dashboards.
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Our Hospital Billing Workflow
A robust, structured workflow is critical for hospital revenue integrity. Our process ensures accurate data capture, regulatory compliance, clean claims submission and efficient collections — minimizing revenue leakage and administrative overhead.
Pre-Registration & Eligibility Verification
Verify insurance, benefits, prior-authorization requirements before admission or service.
Patient Registration & Demographics Entry
Capture all required patient information and payer details accurately.
Charge Capture & Coding
Document all services, procedures, supplies, diagnostics — code accurately using ICD-10, CPT, UB-04.
Claim Submission & Tracking
Submit claims electronically or via paper; track through adjudication.
Payment Posting & Reconciliation
Post payer remittances, patient payments, adjustments, balances.
Denial Review & Appeals
Analyze denials, correct documentation or codes, resubmit or appeal to recover payment.
Accounts Receivable & Credit Balance Management
Monitor outstanding AR, follow-up, refund credits, and close out accounts.
Financial Reporting & Analytics
Provide dashboards and KPIs — cash flow, days in AR, denial rate, revenue capture, and forecast.
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