Healthcare Revenue Cycle Management Services
The CHB Advantage: Optimized Billing Process
Discover how our streamlined RCM services approach accelerates payments while reducing your administrative burden.
Claims Submitted Within 24 Hours
Clean claim rate
EHR Systems Supported
Our Complete RCM Process Explained
At Certified Healthcare Billing, we take a smart, hands-on approach to Revenue Cycle Management helping you streamline operations and boost revenue without the usual headaches. As one of the leading revenue cycle management companies, we focus on efficiency at every step, so you can spend less time on paperwork and more time on what matters most.
Assessment - Analyze Setup
Our process begins with a comprehensive assessment of your current billing operations. Our experts analyze your existing setup to identify:
- Current EHR system capabilities and limitations
- Documentation workflows and efficiency
- Key performance indicators and benchmarks
- Payer mix and contract terms
- Common denial patterns and revenue leaks
This data-driven approach allows us to develop a tailored implementation plan that addresses your specific challenges and goals, establishing a strategic foundation for revenue optimization.
Configuration - Customize Workflows
Based on our assessment findings, we configure our systems to integrate seamlessly with your practices. Our configuration process includes:
- Establishing secure, bidirectional integration with your EHR
- Mapping data fields to ensure complete information transfer
- Setting up specialty-specific rules and protocols
- Configuring payer-specific requirements and rules
- Customizing workflows to match your practice patterns
Our team works closely with your staff during this phase to ensure that the transition is smooth and all stakeholders are comfortable with the new processes.
Claim Submission - Scrubbing & Submission
Our claim submission process leverages advanced technology to ensure clean, accurate claims that get paid the first time:
- Multi-level scrubbing with over 250 validation rules
- Automated coding validation against LCD/NCD policies
- Real-time eligibility verification before submission
- Electronic submission to all major payers and clearinghouses
- 24-hour submission window for 100% of all claims
We identify and correct potential issues before submission, significantly reducing denial rates and accelerating payments.
ERA/EOB - Faster Payments
We accelerate your payment processing through efficient handling of Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) documents:
- Daily electronic retrieval of ERAs from all connected payers
- Optical character recognition for paper EOBs with 99.8% accuracy
- Automated payment reconciliation against submitted claims
- Systematic identification of underpayments based on contract terms
- Immediate flagging of denials for rapid remediation
Our streamlined ERA/EOB processing ensures that payments are processed quickly and accurately, reducing days in A/R and improving cash flow predictability.
Denial Management - Expert Handling
Our dedicated denial management team specializes in recovering revenue that would otherwise be lost:
- Root cause analysis of all denials to identify patterns
- Specialized appeals teams organized by denial type
- Automated tracking of appeal deadlines and status
- Custom appeal letter templates for common denial scenarios
- Systematic follow-up protocol for pending appeals
Rather than simply working denials, we focus on analyzing patterns to implement preventive measures that reduce future denials, creating an ongoing cycle of improvement.
Payment Posting - Accurate & Transparent
Our payment posting process ensures accurate financial records and transparent patient billing:
- Daily payment posting to maintain current financial data
- Line-item reconciliation for complete accuracy
- Precise application of contractual adjustments
- Automated calculation of patient responsibility
- Detailed transaction records for audit compliance
Our meticulous approach to payment posting provides complete visibility into your practice's financial performance and ensures that patients receive accurate bills reflecting their true responsibility.
Optimization - Continuous Refinement
Our commitment to excellence doesn't end with implementation. We continuously refine our processes to maximize your revenue:
- Monthly performance analysis against key metrics
- Quarterly business reviews with actionable insights
- Ongoing payer policy monitoring to adjust billing strategies
- Staff education on documentation improvements
- Workflow adjustments based on performance data
This continuous improvement cycle ensures that your revenue cycle management evolves with changing regulations, payer policies, and practice needs, preventing revenue stagnation.
Solving Your Biggest Revenue Cycle Challenges
Running a healthcare practice in California, whether you’re in a big city like Los Angeles or San Diego, or closer to San Francisco or Orange County, comes with its own set of financial headaches. Things like claim denials, slow claims processing, and keeping up with all the changing rules can really mess with your cash flow and keep you from focusing on what matters most: your patients.
We get it. Here at CHB, we truly understand these struggles and offer smart solutions to make your life easier, boost your income, and improve your overall healthcare financial management.
As experts in RCM services in healthcare, we dive deep to find out why your revenue might be leaking. We use a thorough approach, from meticulously checking claims before they go out to aggressively managing any denials that come back, ensuring you get paid everything you’re owed. By teaming up with us, your practice gets the benefit of our advanced systems and experienced pros who know the ins and outs of medical billing and coding.
This means smoother operations, less paperwork for you, and ultimately, a healthier bottom line so you can thrive in California’s competitive healthcare landscape.
Healthcare Revenue Cycle Management Services
| Topic | Why It Matters? | Actions | Who Should Care? |
| 1. What is Outcomes-Based RCM? | Traditional RCM focuses on transactions. Outcomes-based RCM prioritizes long-term financial performance and patient experience. | – Shift from reactive billing to proactive strategy – Measure success via collection efficiency, patient satisfaction, and net revenue impact | CFO, RCM Director, Practice Owner |
| 2. Front-End Optimization: Start Clean to Finish Clean | 90% of claim issues originate at registration or eligibility. | – Automate eligibility checks and prior auths – Train front desk on coverage nuances and documentation | Office Manager, Front Desk Supervisor |
| 3. Denial Management: Prevention Beats Appeal | Denials delay cash flow and increase AR days. | – Track root causes (coding, auths, coverage errors) – Implement pre-bill edits and predictive analytics | Billing Lead, Claims Specialist |
| 4. Key Metrics That Matter | Knowing what to measure drives better financial decisions. | – Focus on Clean Claim Rate, DNFB, Aging > 90 Days, Cost to Collect – Benchmark performance monthly | CFO, RCM Manager |
| 5. Role of Automation in Modern RCM | Manual processes are costly and error-prone. | – Use bots for claim scrubbing, payment posting, and appeals – Reduce FTE burden, improve speed & accuracy | IT Manager, Billing Supervisor |
| 6. Financial Clearance and Patient Pay Estimation | Patient responsibility is growing — surprise bills damage trust. | – Provide accurate cost estimates up front – Offer payment plans and online tools | Patient Access Manager |
| 7. Interoperability and Data-Driven Insights | Disconnected systems lead to revenue leaks. | – Integrate EHR, clearinghouse, and billing platforms – Use dashboards to monitor and act in real-time | CIO, Ops Manager |
| 8. Outsourcing vs. In-House RCM | Not all practices have bandwidth or expertise to manage billing. | – Compare cost per claim, denial rates, and cash acceleration – Evaluate ROI and transparency of external partners | Practice Owner, Admin Director |
| 9. Compliance and Risk Management in RCM | HIPAA, CMS, and payer rules change frequently. | – Perform regular audits – Stay updated on regulation changes to avoid penalties | Compliance Officer, Billing Manager |
| 10. RCM and Value-Based Care Readiness | As reimbursement shifts to value, RCM must adapt. | – Align billing with outcomes, quality measures, and care coordination – Use risk stratification and care gap insights | Clinical Director, Population Health Team |
All EHR SOFTWARE SUPPORTED
Let's Talk About Your Revenue Cycle Management
During our free consultation, our California-based staff will discuss your needs and let you know how we can help.
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