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

RCM is the full set of administrative, clinical and financial processes a practice uses to submit claims, collect payments, manage denials and optimize reimbursement from scheduling through final payment posting. At Credexa this covers eligibility verification, prior authorization, charge capture, ICD-10/CPT coding review, claim scrubbing and electronic submission, ERA/EOB payment posting, denial management and appeals, A/R follow-up, patient statements, provider credentialing and monthly performance reporting, all handled by a dedicated team inside your existing EHR from 2.99% of collections.

How does outsourcing medical billing work without disrupting my practice?

A trained, dedicated team manages your claims, payments and denials remotely inside your existing EHR. The transition takes 7 to 10 days: we configure HIPAA-compliant role-based access, review your payer mix and denial history and start processing claims alongside your current workflow. Your staff does not change platforms, learn new software or take on extra tasks.

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

Charge capture gaps, undercoded E/M visits, incorrect modifiers, expired prior authorizations submitted as active and denied claims sitting unworked past filing deadlines. These come from small teams handling high volume without built-in quality assurance, not from negligence. Our certified coders review every claim against payer rules and documentation, and every denial is categorized and corrected at the root.

What's included in Credexa's medical billing and credentialing services?

Everything under one team and one rate. Billing covers eligibility, coding review, claim submission, payment posting, denial management, A/R follow-up and reporting. Credentialing covers CAQH management, payer enrollment submission, weekly follow-up, recredentialing tracking and status updates from $99 per enrollment. Both run inside your existing EHR with no separate vendor.

How does Credexa handle claim denials and prevent them from recurring?

Three stages: immediate categorization by denial reason code (CO-16, CO-4, PR-1 and others), prioritized appeals with supporting clinical documentation and upstream root-cause correction. We track denial patterns by payer, provider and code, then fix the workflow or data entry habit that caused them, which is what separates real denial management from simple resubmission.

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

Most practices go live within 7 to 10 days. Onboarding includes EHR access setup, fee schedule review, payer mix analysis, denial history audit and team assignment. We process the first claims while your previous system is still active, so there is no gap in revenue, and your first performance report arrives within the first full billing cycle.

Is Credexa the right fit for a solo practice or only larger groups?

We work with solo practitioners, small groups and multi-provider practices across all 50 states. Solo practices often benefit most because they have the least redundancy; one missed charge or unworked denial has a bigger impact. Percentage-based pricing scales with your collections, so you never pay for capacity you don't use.

What makes Credexa different from other medical billing outsourcing companies?

We find and fix existing gaps in your billing before they compound. Instead of running your process the way your old team did, we audit your revenue cycle during onboarding, identify leaks in claims, denials, coding and A/R and build a corrected workflow: gap identification first, process correction second, ongoing management third.

Is Credexa affordable for small practices?

Yes. Pricing starts at 2.99% of collections with no setup fees, no long-term contracts and no per-claim charges; you pay only on what we collect. For a practice collecting $50,000 a month, that is $1,495 for eligibility, coding, claims, denials, A/R and reporting, versus about $3,000 at a 6% billing company.

How does Credexa pricing compare to hiring an in-house biller?

Typically 30% to 50% less once you count salary, benefits, payroll taxes, software and training. A US biller costs roughly $45,000 to $65,000 per year plus overhead. With Credexa you get a dedicated team and certified coders, remove hiring risk and coverage gaps and pay for results, not hours.

Is Credexa HIPAA compliant and how is patient data protected?

Yes, across every workflow. Access is role-based so each team member sees only what their function requires. We sign a Business Associate Agreement (BAA) before any patient data is accessed, use encrypted transmission, keep access logs and audit trails and leave you with full ownership of all patient records.

What kind of reporting does Credexa provide?

Weekly claim status updates and monthly full-cycle reviews covering collections by payer, denial rates by reason code, clean claim rate, days in A/R by aging bucket, posting accuracy and process recommendations. Reports arrive in your EHR dashboard or a shared document, and a real person who knows your account is always a call or email away.

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Trusted Medical Billing Partner

Outsourced Medical Billing Services That Get Your Claims Paid the First Time

Your practice doesn’t have a patient problem, it has a collections problem. Denied claims, slow payers and an overworked billing team keep revenue stuck. Credexa Solutions takes over your billing so claims go out clean, payments arrive faster and your AR stays under control, starting at 3.9% of collections.

Trusted by 450+ healthcare providers across 28 states

Book Your Free Billing Review

REVENUE REALITY CHECK

Is Your Practice Losing Revenue Without Knowing It?

Denials pile up, accounts receivable age past 90 days and your billing staff is stretched thin. Worse, incomplete reporting hides how much is leaking out every day.

5–10%

Denial Rates Eating Your Revenue

Every reworked claim costs roughly $25–$118, so you pay twice for work that should have been right the first time.

90+ Days

AR Aging Beyond 90 Days

Collection odds fall sharply with every month a claim ages.

$50–70K

Staff Turnover & Training Costs

When a biller leaves, knowledge leaves with them and hiring starts over.

Frequent

Errors Creating Compliance Risk

Each mistake means a denial, a delay or an audit flag.

Blind Spots

No Financial Visibility

Can you see clean claim rate or denials by category right now? If not, you’re deciding blind.

We built our outsourced billing services to remove every one of these problems.

REVENUE CYCLE

Our 8-Step Process

Clean Claim Rate

0 %

Above industry average

vs. 85–92% industry average

Patient Registration & Demographic Entry

Accurate capture of demographics, insurance and referral data at intake.

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Insurance Eligibility & Verification

Real-time checks of coverage, co-pays, deductibles and auth rules before the visit.

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Pre-Authorization Verification

Payer approvals secured comprehensively before the date of service.

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Claims Submission & Charge Entry

Accurate CPT, ICD-10, HCPCS coding, multi-step scrubbing, electronic submission within 24 hours.

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Payment Posting & Reconciliation

Line-level ERA/EOB posting coupled with prompt daily reconciliation.

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Denial Management & Appeals

Root-cause review within 24 hours, appeals within 48 hours, fixes to stop repeat denials.

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AR Follow-Up & Recovery

Systematic follow-up across 30/60/90/120+ day buckets with payer-specific escalation.

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Reporting & Analytics

Monthly dashboards focusing on collection rate, denial rate by category, clean claim rate, and overall revenue trends.

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“Every service connects to the next. Eligibility checks prevent denials, clean charge entry speeds submission, proactive denial work recovers lost revenue and accurate posting keeps your books right.”

Want to see how this applies to your practice?

PERFORMANCE COMPARISON

Why Healthcare Providers Switch to Outsourced Medical Billing

The question isn’t whether outsourcing costs money. It’s whether your current setup is costing you more.

Metric

In-House Billing — Industry Standard

Credexa — Recommended

Annual cost per biller

$50K–$70K salary, benefits, training and software

Clean claim rate

85%–92%

Net collection rate

85%–90%

Denial rate

5%–10%

Average days in AR

40–55 days

Scalability

Hire/fire cycles

Compliance risk

100% on you

Technology cost

$500–$2,000/month

Staff turnover impact

3–6 months lost per replacement

Expertise

Outsourcing buys CPT/ICD-10 expertise, payer-specific rules and denial prevention that take years to build in-house.

Speed

Claims out within 24 hours, denials appealed within 48 hours, AR followed up weekly.

Certainty

A predictable revenue cycle you can plan payroll around.

Want to see what dynamic billing rates look like for your practice?

SUPPORTED COVERAGE

Specialty Medical Billing: Expert Billing for Every Practice Type

Every specialty has its own CPT sets, modifiers, payer rules and documentation standards. That’s why we assign billers trained in yours.

Cardiology

Modifier 26/TC splits and echo bundling

Orthopedics

Global periods and implant billing

Dermatology

Destruction stacking and biopsy bundling

Neurology

EEG/EMG documentation rules

Gastroenterology

Anesthesia crossover for endoscopy

Pulmonology

Sleep study rules and prior auths

Radiology

Professional/technical splits by place of service

Oncology

J-codes and biosimilar substitution

OB/GYN

Global obstetric packages

Pediatrics

Weight-based dosing and vaccine codes

Urology

Lithotripsy global periods

ENT

Sinus endoscopy modifiers

Physical Therapy

Timed 15-minute unit rules

Pain Management

Prior auth variance

Internal Medicine

CCM and AWV under-billing

Family Practice

Preventive vs problem-oriented coding

General Surgery

Multiple-procedure discounting

Ambulatory Surgery

Facility vs professional fee splits

Behavioral Health

Time-based add-ons

Home Health

Face-to-face documentation

Nephrology

Monthly capitation claims

Rheumatology

Biologic prior auths

Ophthalmology

Modifier 79 post-op care

Endocrinology

CGM supply rules

Don’t see your specialty? We cover 75+ specialties and sub-specialties.

OUR PROCESS

How Our Outsourced Medical Billing Services Work: From Day One

Switching billing companies sounds disruptive. We designed onboarding so it isn’t.

Step 1 · Week 1

Free Billing Audit & Revenue Analysis

We review denial rate, AR aging, clean claim rate, net collection rate and payer mix and show where revenue leaks. No commitment.

Step 2 · Weeks 2–3

Custom Onboarding & EHR Integration

Integrate with your EHR/PM system (Epic, Athena, eClinicalWorks, Kareo, DrChrono, AdvancedMD and more), map workflows, verify credentialing, set up your reporting dashboard.

Step 3 · Weeks 3–4

Parallel Billing Transition

We run alongside your current process, then take over, with no claim gaps or missed filing deadlines.

Step 4 · Ongoing

Full Revenue Cycle Management

A dedicated billing team and one account manager as your single contact.

Step 5 · Ongoing

Monthly Performance Reviews & Optimization

Monthly review of collections, denials, AR and clean claim rate, plus proactive payer-rule updates.

Ready to start with Step 1? It’s free.

SUPPORT CENTER

Outsourced Medical Billing: Your Questions Answered

Still have questions?

Can’t find the answer you’re looking for? Reach out to our dedicated support team for personalized assistance with your practice’s medical billing needs.

What are your standard medical billing fees?

Our fees are typically percentage-based, ranging between 4% and 7% of collected revenue. This pricing is aligned with your success; we only get paid when you collect. Rates depend on your specialty, monthly billing volume, and specific EHR requirements.

What services are included in your standard package?

Our standard suite includes the complete revenue cycle management: patient demographic entry, charge capture, claim scrubbing, payment posting, denial management, appeals, and patient statement generation.

What is your average clean claim rate?

We consistently maintain an average clean claim rate of 98.2%. This performance is achieved through proactive claim scrubbing, certified coders, and continuous updates reflecting local carrier rules.

Do you integrate with our existing EHR/EMR system?

Absolutely. We seamlessly integrate with all major EHR/EMR systems including Epic, Cerner, Athenahealth, eClinicalWorks, and NextGen, ensuring zero disruption to your daily clinical workflow.

How long does the onboarding process take?

Onboarding typically spans 30 to 45 days. This structured timeframe allows us to map software integrations, test EDI connections, configure billing rules, and verify credentialing files.

Which medical specialties do you support?

We support over 40 medical specialties, including Cardiology, Family Practice, Mental Health, Orthopedics, Pediatrics, and multi-specialty surgical centers with highly trained billing teams.

How do you handle denied and rejected claims?

Rejected claims are corrected and re-submitted within 24 hours. Denied claims are audited by our recovery specialists, corrected with updated clinical support, and systematically appealed to recoup every dollar.

What reporting and analytics capabilities do you offer?

We offer robust, 24/7 web-based dashboard reporting. Track KPIs such as Days in AR, Net Collection Rate, aging breakdowns, and provider-specific productivity whenever you need.

Are your processes compliant with HIPAA guidelines?

We are fully HIPAA compliant. Our platform uses enterprise-level encryption, multi-factor authentication, secure data storage centers, and all personnel undergo continuous security compliance updates.

How do you handle patient billing inquiries?

Our bilingual customer service representatives act as an extension of your practice, fielding patient calls regarding outstanding balances, payment plans, and statement questions professionally.

Will we have a dedicated account manager?

Yes, every partner is paired with a dedicated Account Manager. You will have direct email, phone, and video access to an expert familiar with your specific office workflow.

What is the typical ramp-up time to see revenue improvement?

Practices usually note an acceleration in cash collections and a material drop in outstanding AR days within the first 60 days following system synchronization.