Intelligent Health Operations. Coding, claims and records.Run for outcomes.
Medical coding, denials and appeals, accounts receivable, clinical documentation and health information management, delivered as outcomes instead of headcount. AI agents do the first pass. Senior reviewers approve what matters.
A short call with a senior expert. No patient information needed.
Work comes in
- Registrations
- Charts to code
- Claims
- Denials & appeals
- Open AR
How we run it
- 1AI agents do the first pass
- 2Senior reviewers approve what matters
- 3Payer rules checked every time
- 4Every step logged for audit
What you get
- Fewer denials
- Faster, cleaner payment
- Audit-ready records
- Outcomes to SLAs
Built on the rules revenue cycle runs on
- ICD-10-CM and ICD-10-PCS
- CPT and HCPCS
- MS-DRG and APC
- Official coding guidelines
- NCCI edits
- X12 837 and 835
- CARC and RARC
- HIPAA
Watch 46 seconds
Fewer denials, faster payment: how we run revenue cycle operations
Read the film as text
- Denials keep coming back.Your best people spend the week on appeals.
- Why it matters80.7% of appealed Medicare Advantage denials were overturned in 2024. Source: KFF, January 2026
- A claim's path, run for outcomes.Registrations. Charts to code. Claims. Denials & appeals. Open A/R. AI agents do the first pass. Senior reviewers approve what matters. Every step is logged for audit.
- The numbers we agree first.Denial rate. Days in A/R. Cost to collect. (illustrative charts) Agree the measure first. Report plainly.
- During Health.Fewer denials. Faster, cleaner payment. Book a revenue cycle review, or Free readiness scorecard, at duringhealth.com.
What is changing in revenue cycle right now
Dated facts, each with its source. This part of the page is refreshed regularly; the rest is built to last.
13 hours
a week spent on prior authorization per physician
The AMA’s 2025 survey of 1,000 physicians found about 40 requests a week, 95% of physicians reporting care delays and 40% employing staff who work only on prior authorization.
80.7%
of appealed Medicare Advantage denials were overturned in 2024
Insurers made 52.8 million prior authorization determinations in 2024 and denied 7.7% in full or in part, yet only 11.5% of denials were appealed.
2.3%
FY 2027 inpatient payment update
CMS’s final rule (released July 31, 2026) builds it from a 3.2% market basket less a 0.9-point productivity adjustment. It makes the CJR-X joint replacement model mandatory from January 1, 2028, and electronic prior authorization an optional bonus measure for hospitals in 2027 and required in 2028.
CMS FY 2027 IPPS/LTCH PPS final rule fact sheetAs of Oct 2026−1.68%
proposed CY2027 Medicare conversion factor change
For most physicians, from $33.40 to $32.84, driven mainly by the expiring 2026 one-year 2.5% increase. A final rule is expected in November.
Our CY2027 fee schedule analysisAs of Oct 2026
Jan 1, 2027
payer FHIR APIs go live
CMS-0057-F requires Patient Access, Provider Access, Payer-to-Payer and Prior Authorization APIs: new, structured data streams that only organizations with a ready foundation can use.
Every number links to its source.
What most revenue cycle teams get wrong
Myth
“Denials are a billing problem.”
Fact
Many denials start before the claim exists: at registration, authorization, documentation and coding. Preventing them at the source costs less than appealing them later.
Myth
“AI will replace our coders.”
Fact
AI is good at the first pass. Coding still needs people who can read a record, apply the guidelines and answer a payer. The aim is to give experts more time for the hard cases, with every AI suggestion open to review.
Myth
“Outsourcing means losing control.”
Fact
Outcome-based work should give you more visibility, not less: named owners, agreed service levels, audit trails and reports that tie each result to a cause.
Four things you can hold us to.
Medical coding
AI-assisted coding with expert validation for accuracy and compliance.
What you get
- Inpatient, outpatient, professional and risk-adjustment coding
- AI-assisted first pass with expert review
- Accuracy audited on a sample you can inspect
- Official guidelines, NCCI edits and payer rules applied every time
Denial management & appeals
Predict, prevent and recover — including generative appeals with human review.
What you get
- Denial root-cause analysis by payer, reason and department
- Appeal letters drafted with AI and approved by a human reviewer
- Deadline and outcome tracking for every appeal
- Prevention fixes fed back to registration, coding and documentation
AR & collections
Prioritized follow-up that improves collection efficiency.
What you get
- Work queues ranked by value and likelihood of payment
- Payer follow-up and underpayment checks
- Patient balance workflows that stay respectful
- Clear reporting of days in AR and aging
Clinical documentation (CDI)
Close documentation gaps that drive denials and revenue leakage.
What you get
- Documentation gap review and compliant provider queries
- Focus on clarity, specificity and medical necessity
- Feedback loops that help providers document well the first time
- Query-rate and response-time metrics
Everything we do in revenue cycle and health information management
Ten service areas, from the front desk to the last dollar collected, plus the records behind every claim. Most engagements start in one and grow into the others.
Patient access & registration
Getting the claim right before the patient is seen.
- Eligibility and coverage verification
- Prior authorization tracking
- Good-faith estimates and price transparency support
- Registration accuracy checks
Charge capture & charge master
Making sure every service becomes a charge.
- Charge-to-service reconciliation
- Charge-master review and upkeep
- Missing and late-charge detection
- Revenue-leakage reporting
Medical coding
Accurate, supported codes from the record.
- Inpatient, outpatient and professional coding
- ICD-10-CM and PCS, CPT and HCPCS
- Risk-adjustment (HCC) coding
- Coding audits and provider education
Clinical documentation integrity
Records that say what happened, clearly.
- Compliant provider queries
- Specificity and medical necessity review
- Provider feedback and education
- Query and response metrics
Claims & billing
Clean claims, sent and acknowledged.
- Claim scrubbing against payer and NCCI edits
- Electronic submission and acknowledgments
- Same-day rejection handling
- Secondary and coordination-of-benefits billing
Payment posting & reconciliation
Knowing exactly what was paid and why.
- Electronic remittance (835) posting
- Adjustment and write-off review
- Deposit and bank reconciliation
- Patient-responsibility transfer
Denial prevention & appeals
Stopping denials, and winning the ones that happen.
- Denial categorization (CARC and RARC)
- Root-cause analysis and prevention
- Appeal drafting with human sign-off
- Payer trend reporting
AR follow-up & collections
Working the oldest, biggest and likeliest balances first.
- Prioritized work queues
- Payer follow-up and escalation
- Patient balance and payment-plan workflows
- Days-in-AR and aging reporting
Underpayments & contract performance
Collecting what the contract says you are owed.
- Expected-versus-paid variance
- Payer contract modeling
- Underpayment appeals
- Payer dispute support
HIM operations
The record behind every claim, kept complete and safe.
- Release of information
- Record completion and deficiency management
- Master patient index and duplicate cleanup
- Scanning, indexing and retention
How an engagement runs: start with one service line, not the whole department
You see measured results against your own baseline before you widen the scope.
Baseline
Measure where money and time are lost today: denials, AR, coding accuracy and backlog.
You get
Baseline report and a ranked list of fixesPilot
Run one service line or one payer with agents and reviewers, alongside your team.
You get
Measured results against the baselineRun
Take over the workflow under agreed service levels, with weekly reporting.
You get
A service-level dashboard and named ownersImprove or transfer
Feed denial causes back upstream, add service lines, or hand the work back to your team.
You get
Playbooks, training and an optional build-operate-transfer path
Who we run this for
Hospitals and health systems
The problem
Denials, coding backlogs and AR aging eat margin, and teams are stretched thin.
A good first project
One service line or payer, with a weekly denial and AR view.
Physician groups and MSOs
The problem
Several practices, several billing habits and no single view of performance.
A good first project
Shared coding review and denial prevention across practices.
Specialty, ambulatory and imaging centers
The problem
High volume of similar claims, where small errors repeat thousands of times.
A good first project
Front-end accuracy and a clean-claim workflow.
Revenue cycle teams under staffing pressure
The problem
Open roles and backlogs mean the hard accounts never get worked.
A good first project
Take over a defined queue so experts focus on the hard cases.
Is your revenue cycle ready for outcome-based work?
If you cannot tick most of these today, measurement is the first project, before anyone takes over a workflow.
- You can see denials by payer, reason and department every week.
- Registration errors are measured and fed back to the front desk.
- Coding accuracy is audited on a sample, and the results are shared.
- Every appeal has an owner and a deadline.
- AR over 90 days is worked from a ranked list, not in account order.
- Clinical documentation queries are compliant and tracked.
- Payer contracts are loaded, so underpayments are found automatically.
- Every AI-assisted step has a named human reviewer and a log.
Three questions to ask your team on Monday
- 01
What share of our denials could we have prevented before the claim was sent?
- 02
Who owns each appeal, and how many expire without anyone working them?
- 03
If our best coder left tomorrow, what would break first?
If the answers are slow or different in every room, that is where we start.
Check our thinking before you call us
We publish how we read the rules and give away the tools. Judge the depth for yourself.
- Article
NCCI edits explained: PTP edits, MUEs, modifiers and add-on codes
How Medicare decides what can be billed together, in plain terms.
- Article
Medicare EDI and HIPAA transactions explained
Every message in the life of a claim, and what each reply means.
- Tool
NCCI edit helper
A plain-English answer to a Medicare coding denial.
- Download
HIM technology readiness self-assessment
A 15-page workbook to score a new technology before you sign.
Do you replace our revenue cycle team?
Only if you want us to. We can work beside your team on one service line, take over a defined workflow, or build a function and then transfer it back to you.
How do AI agents fit with coders and reviewers?
Agents do the first pass: reading the record, suggesting codes and drafting appeals. Experienced reviewers check and approve anything consequential. Accuracy is audited on samples you can inspect, and every step is logged.
Will this push us toward upcoding?
No. We follow the official coding guidelines and CMS rules, send anything uncertain to a human reviewer and keep audit trails. The goal is accurate, supported coding, not higher payment for its own sake.
What does outcome-based mean, and what do you measure?
We agree the measures up front, such as denial rate by cause, days in AR, coding accuracy, clean-claim rate and turnaround time, and report them weekly. You pay for the result, not for hours.
Do you work inside our systems?
Yes, through role-based access you control in your EHR, practice management system and clearinghouse, or in a secure environment agreed in writing. Read our trust center for how we handle sensitive data.
How do you protect PHI?
Only under a written agreement, including a business associate agreement where HIPAA applies, signed before any PHI is shared. We use the minimum necessary, role-based access, encryption and audit logging.
How is an engagement priced?
It depends on the scope and the work. We scope a first service line or payer with agreed measures, so you can compare the results before you widen the scope.
Start with one service line. Prove it, then scale.
Tell us where revenue or records are slowing you down. We will tell you what the data should show, what we would change first and how we would measure it.
Please do not send patient information. Describe the situation without identifying anyone.