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HOSPITAL REVENUE CYCLE MANAGEMENT SERVICES

Hospital Revenue Cycle Management Services Built Around Facility and Professional Billing

A single hospital encounter usually produces two separate claims. The facility claim goes out on the UB-04, billing for the hospital's own charges. A separate professional claim, on the CMS-1500, covers the physician's own work. Miss that split, or bill either one wrong. One claim holds up the other.

MedSole RCM tracks facility and professional claims as two distinct billing streams that still tie back to one patient encounter. Our coders assign DRG and APC classification by payer rule, department by department. Everything reconciles into one system-level report.

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99%

Clean Claim Rate

4,000+

Providers Served

50+

EHR/EMR Systems Supported

2.5%

of Collections

HOW HOSPITAL BILLING SPLITS

How hospital billing splits by encounter type

A hospital doesn't bill one way. Four different billing logics run inside the same building, and each has its own rules for what gets paid.

Inpatient stays run on DRG

DRG stands for diagnosis-related group. Medicare pays one fixed amount for the whole stay based on diagnosis and procedures, not days spent. Undercode a single comorbidity, and the case drops into a lower-weighted DRG. Our coders check every documented complication before the claim goes out, not after an audit flags it.

Outpatient visits run on APC

APC groups each outpatient service, an imaging test, a same-day procedure, into its own payment category instead of one lump sum. A missed charge on any single line item is real, isolated lost revenue. We code each service on its own, not toward one number.

The emergency department often bills twice

One ER visit usually produces two claims: a facility claim and a separate physician claim. Both have to hold up alone. ED coding also draws more medical-necessity challenges than almost any other department, and we appeal around that specific pattern.

Observation status sits in a real gray zone

Medicare's two-midnight rule decides whether a stay bills as inpatient or observation. Guess wrong, and the hospital either collects the lower rate for care that should've billed inpatient, or faces an audit for the reverse. We track status changes as they happen, not after discharge.

Coordinating Claims Across Departments

Coordinating claims across
every department that generates one

Emergency, surgery, radiology, lab, inpatient units, outpatient clinics: each generates its own claims, at its own volume, with its own denial pattern. None of that lines up on its own.

Tracked by department icon

Tracked by department

A radiology department's clean claim rate can look fine while surgery's denial rate quietly climbs, and nobody notices until the numbers get pulled together for one report. We track every department separately, then reconcile all of it into a single system-level view.

Credentialed by department icon

Credentialed by department

A hospital adding providers across several departments at once needs each one enrolled with the right payers before that department's claims can go out. We track credentialing status by department, so one slow enrollment doesn't stall a department that's ready to bill.

Department claims coordination
STAYING AHEAD OF RAC AUDITS

Staying ahead of RAC audits and DRG reviews

Recovery Audit Contractors review inpatient claims for DRGs that don't match the documentation on file. A hospital's audit exposure grows every reporting cycle it goes unreviewed internally.

Our System
01

Validating before submission

We check every DRG-affecting diagnosis against the clinical documentation before the claim goes out, the same standard a reviewer applies after the fact. Catching the gap first means the claim never becomes a target.

02

Answering requests on time

When an auditor requests records, we pull the documentation and respond inside the payer's deadline, with the coding rationale already on file and ready to send.

03

Turning findings into prevention

An audit finding traces back to the coding pattern behind it, and that pattern gets corrected across future charts. The same mismatch doesn't repeat on the next patient.

04

Appealing every recouped claim

We appeal every recouped payment, using the original documentation and clinical rationale, and follow it through the payer's full review process.

05

Logging every review

Our team logs every audit and its outcome, building a documented history the hospital can point to at its next review cycle.

WHERE DOES YOUR SYSTEM FALL BEHIND

Which of these sounds like your hospital right now

Most hospital revenue problems stay buried inside one department until they show up in a consolidated report weeks later. Check what's actually happening below.

Get a real look at where the gaps are

A free review checks a sample of claims across departments and shows you where billing, coding, and credentialing are actually falling behind. No cost, no obligation.

HOW HOSPITALS ENGAGE MEDSOLE

One rate for hospital-scale collections

One percentage covers the full hospital revenue cycle, priced for the volume that hospital-scale collections bring.

HOSPITAL RCM
2.50 %
of collections
No per-department invoicing

Hospital-scale collections run at a lower rate

Hospital RCM runs at 2.5% of collections, below the 2.5% rate MedSole charges private practices. Collections volume at hospital scale changes the math on what the service costs per dollar recovered.

Every department runs under one rate

Facility billing, professional billing, DRG and APC coding, department-by-department credentialing, and RAC audit support all fall under that single rate. Nothing bills separately, and no department gets its own invoice.

Credentialing keeps its own flat rate

It's $99 per provider per payer, the same rate MedSole uses across every service. At hospital scale, that usually covers several providers across several payers at once, not a single application.

Get your hospital RCM rate
WHAT PRACTICES ASK

Questions Practices Ask About Payment Posting

These are the questions practices usually ask before handing posting off to someone else.

Still have a question we didn't cover?

Tell us what's going on with your posting, and someone who actually works remittances will get back to you.

Q1 What is payment posting in medical billing?

Payment posting is the step where a payer's remittance, an ERA file or a paper EOB, gets matched to the claim it's paying for. A biller checks the amount against your contracted rate, records any adjustment or write-off, and updates what the patient still owes. It happens after a claim gets paid or denied, and it's the step that shows whether the practice actually collected what it was owed.

Q2 What's the difference between an ERA and an EOB?

Both documents explain how a payer processed a claim, but they arrive differently. An ERA is an electronic remittance file that a system can read and post automatically, often covering many claims in one batch. An EOB is the paper or PDF version, usually covering a single claim, and it has to be read and entered by hand unless the payer offers an electronic option. Most payers send one or the other, and a practice working with several payers usually handles both.

Q3 Does payment posting cost extra if I'm already running full RCM with MedSole?

No. Payment posting doesn't carry its own charge. It's included in full-service RCM at 2.5% of collections, the same rate that covers registration, coding, claims, and AR follow-up. You're not billed twice for one piece of the cycle, and the team checking your remittances against your contracted rates is the same team already running the rest of your billing. If a shortfall shows up in posting, it often points to something upstream, and one team catches both instead of two vendors each seeing half the picture.

Q4 Is payment posting the same as AR follow-up?

No. Payment posting happens when a payment arrives and gets checked against the claim and your contracted rate. AR follow-up happens when a claim hasn't been paid at all, and someone has to chase the payer to find out why. A posting problem can turn into an AR problem if a short payment sits unflagged long enough, but they're two different jobs. MedSole runs both under one team, so a gap in one gets caught by the other instead of falling between them.

Q5 Can this work inside my existing EHR or practice management system?

Yes. We post payments directly inside the EHR or practice management system your practice already runs, whether that's an ERA file read automatically or a paper EOB entered by hand. Nothing moves to a separate platform, and your front desk sees the same claim record either way. If you use a clearinghouse for remittances, we work inside that too.

Q6 Is this HIPAA compliant?

Yes. We sign a Business Associate Agreement before we access a single remittance, and every payment we post moves through encrypted, HIPAA-compliant channels. Your practice keeps full access to every record at all times.

YOUR FREE REVIEW

See What Your Posting Is Actually Catching

A free review checks a sample of your recent remittances against your contracted rates and shows you where the gaps are. No cost, no obligation, and we sign a BAA before we look at anything.

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Contracted-rate gap review

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