What is the difference between medical billing and revenue cycle management?

Medical billing is the submission and follow-up of insurance claims. Revenue cycle management covers the full financial lifecycle of a visit, from registration and eligibility through coding, submission, posting, denials, and patient collections. Billing is one stage of the cycle. If claims are the only thing you need handled, our medical billing services cover that stage on its own. If revenue is leaking between stages, you need the whole cycle managed.

What happens when one stage of the revenue cycle fails?

That is the question most practices should be asking. A denial caused by an eligibility error at registration sits between two vendors while each waits for the other. With one team, the denial gets traced back to registration, the process gets corrected there, and the same denial stops recurring. Nobody has to agree on whose fault it was first.

Can I outsource only part of the revenue cycle?

Yes. Some practices hand us denials and accounts receivable while keeping charge entry in-house. Others start with credentialing and add billing later. We scope to what you actually need. The full cycle costs less per stage than assembling it from separate vendors, but you are not required to take all of it.

Who do I actually talk to?

One account manager who knows your practice, your payers, and what happened at every stage. Not a ticket queue, and not a different person each time you call. When a claim goes wrong, the person you reach can see where it started without transferring you.

How do you report across every stage?

One report, tied to collected revenue rather than submitted claims. You see denial rate by category, days in accounts receivable by aging bucket, net collection rate, and collections by payer. Because one team runs every stage, the report shows which stage caused a problem rather than just that a problem exists.

Is outsourcing the revenue cycle worth it for a small practice?

Small practices often gain the most. A solo or small practice running one or two billers carries the highest risk, because when that person leaves or takes leave, billing stops and cash flow stalls. Outsourcing gives you a full billing department with no salary, software, benefits, or training to cover, and no single point of failure.

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ACCOUNTABLE REVENUE OPERATIONS

Outsourced Revenue Cycle Management Services for Medical Practices

Q: When should a practice outsource its revenue cycle?

Four signals point to it: denial rate climbing above 5%, accounts receivable stretching past 45 days, biller turnover disrupting cash flow, or adding providers faster than you can credential them. The free audit is the right first step. It shows exactly where revenue is leaking before you commit to anything.

A claim comes back denied for an eligibility error your front desk made three weeks ago. You call the billing company, they point at the front desk. You call the front desk, they point at the software. Nobody owns it, and the claim ages.

That is what four vendors buys you. Each is responsible for a stage, none for the outcome, and the gaps between them are where revenue goes missing.

MedSole runs all ten stages as one operation, from registration through reporting, with one account team that answers for the whole cycle and one report tied to what you actually collected.

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See Where Your Revenue Is Leaking

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FULL-SERVICE RCM

Every Stage of Your Revenue Cycle,
Managed Under One Roof

Most practices work with three or four vendors who never speak to each other. A denial sits between them for six weeks while each waits for the other to move. MedSole handles every stage under one strategy, one account team, and one report tied to collected revenue.

Patient Registration and Eligibility Verification

Wrong insurance information at check-in is where most denials start. We verify benefits and eligibility before every visit, so claims leave clean the first time. A mistake caught at registration costs a few minutes. The same mistake caught after submission costs weeks.

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Prior Authorization Management

Authorization delays stall care and trigger denials your team didn't see coming. We handle the requests, the payer follow-ups, and the appeals when an auth gets refused. Your clinical staff stops sitting on hold with payers and gets back to patients.

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Medical Coding (CPT, ICD-10, HCPCS)

Our coders are trained by specialty, not just by code set. That difference captures every billable procedure, prevents downcoding, and keeps you audit-ready across CPT, ICD-10, and HCPCS. A cardiology chart and a behavioral health chart don't code the same way, and our team knows it.

Charge Capture and Claim Submission

Missed charges and late submissions leak revenue faster than almost anything else. We capture every charge, scrub every claim against payer edits, and submit daily. Nothing sits waiting. If you only need claims handled rather than the full cycle, our medical billing services cover that stage on its own.

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Payment Posting and Reconciliation

Money comes in, but the ledger only helps if it's accurate. We post ERA and EOB payments against your ledger daily, flag underpayments, and reconcile every discrepancy. You always know what was paid, what was shorted, and what's still owed.

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Denial Management and Appeals

We work every denial to root cause instead of just refiling it. CO-16, CO-97, CO-50, and OA-18 each get specialty-specific appeals that recover what most practices write off. A refiled claim with the same error gets denied again. We fix the cause.

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Accounts Receivable Follow-Up

Aged AR is your money sitting in someone else's account. We follow up on every outstanding claim by age bucket, payer, and denial reason. Practices that outsource AR follow-up see days in AR drop inside the first 90 days, because nothing gets left to age out.

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Patient Billing and Collections

Patient balances are harder to collect than they used to be, and a bad statement costs you goodwill. We send clear, compliant statements, set up payment plans, and handle self-pay follow-up. Your front desk stops carrying collection calls it was never staffed for.

Provider Credentialing and Payer Enrollment

We credential providers and enroll them with commercial payers, Medicare, and Medicaid, then track every application through CAQH and PECOS. An unenrolled provider cannot bill at all, which is why credentialing sits inside the revenue cycle rather than beside it.

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Revenue Reporting and Analytics

Every report ties back to collected revenue, not submitted claims. You see denial rate by category, days in AR by aging bucket, and net collection rate each cycle. No vanity metrics. No lag. Because one team runs every stage, the report shows which stage caused a problem rather than just that a problem exists.

Four vendors means four people who can each say the problem belongs to someone else. One vendor means one number to call and one team that already knows what happened at registration. Every service above is included in a single engagement. No setup fees. No long-term contracts. Want to see where your revenue cycle is leaking?

Get Your Free Revenue Cycle Audit

Our Process

From First Call to First Clean Claim: How We Run Your Revenue Cycle

Most billing companies hand you a list of tasks. We run a connected system where each step depends on the one before it. Skip or weaken any step, and the next one pays the price.

Most practices complete the transition and begin live claim submissions within 7 to 10 business days. Here's how our revenue cycle management services work when we manage the whole process.

Step 1 · Days 1 to 7

Discovery and Setup

We review your current clean claim rate, denial patterns, AR aging, and payer mix before we charge anything. The audit shows exactly where revenue is leaking and what recovery takes. Most practices find 5 to 8 areas of immediate improvement. We sign a BAA before we access anything.

Step 2 · Pre-Service

Eligibility and Authorization

Before every encounter, we verify patient coverage in real time: active plan, copay, deductible, and prior authorization requirements. Problems caught here never become denials downstream. This is the cheapest place in the entire revenue cycle to catch an error, and the most expensive place to miss one.

Step 3 · Claim Submission

Coding Review and Clean Claim Submission

We capture charges daily by reconciling your schedule against entered encounters. ICD-10, CPT, and HCPCS codes get reviewed against payer documentation rules before submission. Claims pass through payer-specific edit logic for bundling conflicts, modifier requirements, and place-of-service rules. The target is first-pass clean claim acceptance on every claim.

Step 4 · Post-Payment

Payment Posting and Denial Resolution

We post ERA and EOB payments and reconcile them on the day of receipt. Denied claims get categorized by denial reason code, appealed with supporting clinical documentation, and corrected at root cause. Refiling without fixing the upstream cause is why the same denials keep reappearing. We fix the cause.

Step 5 · Ongoing

A/R Follow-Up and Performance Reporting

We work aging claims daily, prioritized by dollar value and timely filing deadline. You receive regular performance reports showing collections by payer, denial rates by category, days in AR by aging bucket, and recommended adjustments. No black box. You get full visibility into every stage of your revenue cycle.

Ready to see what your practice is leaving on the table? Start with a free revenue cycle audit.

THE OPERATIONAL DIFFERENCE

Why Practices Choose MedSole for Outsourced Revenue Cycle Management

Reporting Tied to Collected Revenue, Not Submitted Claims

Most billing companies report on what they sent out. We report on what came back. Your clean claim rate, denial rate, and net collection rate get measured against what you deposited, not what was billed. You stop watching a vendor and start reading a financial statement.

One Accountable Team for Every Stage

When registration, coding, claims, denials, and accounts receivable all run under one team, a problem at any stage gets traced to its source instead of passed between vendors. Nobody has to agree on whose fault it was before the work starts.

Escalation That Does Not Start From Zero

When a claim stalls, the person you reach already knows what happened at registration, what the payer said last week, and what was tried. You are not re-explaining your practice to a new ticket every time.

Your Accounts, Your Data, Your Assets

Your billing accounts, payer portals, and dashboards all stay in your practice name. We never hold data as leverage. If you ever move vendors or bring billing in-house, everything transfers cleanly. We sign a BAA before we touch any PHI, and we stay your business associate, not the owner.

BUILT FOR YOUR PRACTICE

Outsourced RCM for Solo Providers, Group Practices, and Hospital Systems

Solo providers, group practices, multispecialty clinics, and hospital systems each carry a distinct kind of billing risk. One person handling billing alone can fail in a single afternoon. A group without shared reporting loses coordination as it grows.

A multispecialty clinic loses track of which service line is working. A hospital system loses visibility across departments and locations without one consolidated view. MedSole RCM scopes its approach to the practice in front of it, not one template stretched across every size.

Solo Providers

A solo practice running one or two billers carries the highest revenue risk. When that biller leaves, billing stops. We give independent practices a full billing department for less than one full-time hire, so you focus on patients.

Group Practices

Group practices need coordinated billing across multiple providers, tax IDs, and specialties. We run every provider under one strategy, with reporting by provider, specialty, and payer. Denial trends across the group get caught and fixed before they compound.

Multispecialty Clinics

Multispecialty clinics carry the most complex billing environment of any practice type. Every service line has its own coding rules, prior auth, and payer behavior. We staff billers by specialty, so each line gets coded and billed accurately.

Hospitals and Health Systems

Hospital-level RCM demands scale and coordination most vendors can't deliver. We handle facility billing, professional billing, and credentialing across every department, with a dedicated account team per location and consolidated revenue reporting at the system level each cycle.

Specialty Expertise

Specialty-Specific Billing That Knows Your Payer Rules, Not Just Your Specialty Name

Most billing companies list your specialty on their website and call it coverage. MedSole knows your specialty by its denial triggers, modifier requirements, coding edge cases, and payer-specific documentation standards. MedSole RCM covers over 75 specialties. Here are the billing challenges our team manages daily.

Don't see your specialty listed? We cover 75+ disciplines across all 50 states. Tell us yours, and we'll confirm the coverage and payer rules that apply to it.

BILLING AND REVENUE CYCLE CLIENTS

The Practices Who Handed Us Their Whole Revenue Cycle

Most practices find us through credentialing. These six went further and gave us the billing, the denials, and the reporting as well.

Isabella Saffioti

Occupational Therapist

Little Star Pediatric Therapy

"I cannot thank Medsole RCM for all they've done"

I cannot thank Medsole RCM for all they do for my practice. I was previously using a different billing company who was making several mistakes with my billing, I was not getting paid and it was a complete mess. I switched over to Medsole RCM at the end of August the week of my wedding and I am so happy I did. Medsole has been amazing. Andrew has been helping me with all of my billing and he even was able to get me a higher reimbursement rate with two insurance companies. I cannot wait to continue to grow my private practice with Medsole!

Svetlana McGrath

Nurse Practitioner, Pediatrics

Tongue To Toes Newborn and Family Clinic

"Very satisfied"

I am very satisfied with the services I have been receiving from Medsole for the last few years. This team has helped me to run my private medical practice very smoothly. I truly appreciate Jack and his help with the credentialing, Andrew and his help with billing and Alex with all the miscellaneous questions we have had. Thank you.

Twila Jones Mojica

Mental Health Counselor

Talk With Twila Ministries LLC

"Pleased with services"

I have found Medsole RCM LLC to be knowledgeable, professional, and courteous in regard to credentialing and billing. I found Stephen to be very patient as I had a loss in the family. Andrew communicates in real time and the turnaround for payments moves rather quickly. I highly recommend Medsole RCM for those in private practice.

Yzetta Martinez

Licensed Mental Health Counselor

House of the Sacred Journey INC

"Excellent Service and Responsiveness!"

I've been incredibly pleased with the professionalism and efficiency of Medsole RCM LLC. Their team responded quickly and thoroughly when it came to checking credentialing and addressing any discrepancies reported by patients regarding their insurance coverage. It's clear that they take their role seriously and are committed to making sure everything runs smoothly on the back end. Their attention to detail and prompt communication have made a noticeable difference in how confidently we can move forward with patient care. I truly appreciate the support!

Andrea Piazza

Licensed Mental Health Counselor

Dreavita Counseling Coaching and Consulting INC

"Medsole is a practice saver"

Medsole is an excellent and irreplaceable business partner. We keep coming back to them for more and more services because we trust their work that much. I would highly recommend them to anyone looking for a credentialing, billing or VMA vendor.

Cleavon Matthews

Counselor

Professional Practical Solutions Counseling LLC

"Revenue definitely increased"

Excellent services. Jack and the team made the credentialing experience pretty seamless. I also contracted with them to do monthly billing and my revenue definitely increased.

We Move Into the Software You Already Use

You don't switch platforms to work with us. We move inside your EHR and bill from the system your team already knows, so there's no migration, no retraining, and no gap in claim submission. We work across 50+ EHR and practice management systems, and if yours isn't listed, we'll integrate with it.

SUPPORT CENTER

Revenue Cycle Management: Questions Practices Ask Before Switching

Everything you need to know about our services, pricing, onboarding, and how we protect and grow your revenue cycle.

Still have questions?

Can't find the answer you're looking for? Our billing specialists are ready to walk you through every detail of your revenue cycle.

Q1 What are revenue cycle management services and what do they include?

Revenue cycle management is the full process that captures, manages, and collects revenue from patient care, start to finish. It covers eligibility verification, coding, charge capture, claim submission, payment posting, denial management, AR follow-up, and patient billing. Outsourced revenue cycle management hands that entire process to a specialist team. With MedSole, it's one team, one report, and one rate tied to what you collect.

Q2 How does outsourcing medical billing work without disrupting my practice?

You keep your EHR and your workflow. We move inside the system you already use, so there's no platform switch and no gap in claim submission. We handle billing behind the scenes while your front desk and providers keep working exactly as they do now. Onboarding runs in parallel with live billing, so nothing stops while we transition your account.

Q3 What types of billing errors does MedSole catch that in-house teams commonly miss?

Most missed revenue traces to a few repeat errors: eligibility not verified before the visit, expired authorizations, missing modifiers, mismatched patient data, and undercoded encounters. Each one gets caught at the point it happens, not after the denial. Our billers are trained by specialty, so they catch the coding and payer-rule gaps a generalist misses on your claims.

Q4 What's included in MedSole's medical billing and credentialing services?

Everything in the revenue cycle runs under one team: eligibility, prior authorization, coding, charge capture, claim submission, payment posting, denial management, AR follow-up, patient billing, and provider credentialing. You don't juggle separate vendors for separate stages. One account team owns the whole cycle, and one report shows how every stage performed against collected revenue.

Q5 How does MedSole handle claim denials and prevent them from recurring?

We work every denial to root cause instead of just refiling it. CO-16, CO-97, CO-50, and OA-18 each get specialty-specific appeals with supporting documentation. Then we fix the upstream cause so the same denial stops repeating. Refiling without fixing the cause is why denials keep coming back on most practices' reports.

Q6 How quickly can my practice go live with MedSole after the first call?

Most practices are fully onboarded and live within 7–10 business days. That includes EHR integration, account setup, and collecting credentialing documentation. Claims go out on day one of live operations. If you need payer enrollment or recredentialing, those run in parallel and complete within 30 to 90 days depending on the payer.

Q7 How much does outsourced revenue cycle management cost?

MedSole charges 2.99% of collections, with no setup fees and no long-term contracts. Compare that to one in-house biller at $45,000 to $65,000 a year in salary alone, before software, benefits, and training. Most practices see net savings within the first billing cycle, because you only pay on what actually comes in.

Q8 Which company offers the lowest medical billing rates with no hidden fees?

A clean claim rate is the percentage of claims that clear payer first-pass edits without a rejection. We maintain a 99% clean claim rate. The in-house benchmark runs 85 to 92%. A lower rate means more manual rework, longer days in AR, and higher administrative cost for every dollar you collect.

Q9 When should a practice outsource its revenue cycle management?

Four signals point to it: denial rate climbing above 5%, AR days stretching past 45, biller turnover disrupting cash flow, or adding providers faster than you can credential them. The free audit is the right first step. It shows exactly where your revenue leaks before you commit to anything.

Q10 What is the difference between medical billing and RCM?

Medical billing is the submission and follow-up of insurance claims. Revenue cycle management covers the full financial lifecycle of a visit, from registration and eligibility through coding, submission, payment posting, denial management, and patient collections. Billing is one stage of RCM. We cover every stage, so no revenue falls through the gaps between functions.

Q11 Do I keep ownership of my billing accounts and data?

Yes. Every account, portal, dashboard, and report stays in your practice name. We operate as your business associate, not the billing owner. We sign a BAA before we access any data, and you keep full access at all times. If you ever move vendors or bring billing in-house, everything transfers cleanly with no holdbacks.

Q12 Is outsourcing revenue cycle management worth it for a small practice?

Yes, and small practices often gain the most. A solo or small practice running one or two billers carries the highest risk: when that biller quits or takes leave, billing stops and cash flow stalls. Outsourcing gives you a full billing team for less than the cost of one in-house hire, with no salary, software, benefits, or training to cover. You get a 99% clean claim rate, faster payments, and fewer denials, all measured against what you actually collect. Most practices see net savings within the first billing cycle.

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FREE BILLING AUDIT

Find Out How Much Revenue Your Practice Is Leaving on the Table

Our free billing audit reviews your clean claim rate, denial patterns, and AR aging to show you exactly where revenue leaks before it reaches your bottom line. This is the first step toward outsourced revenue cycle management that pays for itself. No cost. No commitment. We sign a BAA before we touch anything.