Revenue Cycle Management Services for Physician Practices

Revenue cycle management is everything that happens between a patient booking a visit and the last dollar of that visit landing in your bank account. Most practices already do some of it well and lose money in the gaps between steps: a charge that never gets entered, a denial nobody works, a payer that pays less than the contract says, a new physician whose enrollment is still pending when claims go out. Our job is to close those gaps and show you, every month, where your money is.

We work in your practice management and EHR system, under your tax ID, with your payer contracts. You keep your software and your data. We take over the work, the follow-up and the reporting.

What’s Included

Every stage below is handled by one team, with one point of contact for your practice manager.

• Eligibility and benefits checks — coverage confirmed before the visit, so fewer claims come back for eligibility reasons.
• Charge capture and coding review — AAPC-certified coders review charges against the documentation, flag missing charges and query providers when the note doesn’t support the code.
• Claim scrubbing and submission — every claim checked against payer and coding edits before it leaves, then submitted electronically and tracked through acknowledgment.
• Denial management and appeals — each denial worked by root cause, corrected and resubmitted or appealed, with the cause fed back to the front desk or the coder so it doesn’t repeat.
• A/R follow-up — open claims worked by payer and by aging bucket, starting with the balances most likely to be lost to timely-filing limits.
• Payment posting and underpayment recovery — ERAs and paper EOBs posted, deposits reconciled to the bank, and payments compared with your contracted rates so short-pays get disputed.
• Patient statements — clear statements after insurance has paid, with a phone line patients can call about their balance.
• Monthly reporting — collections, denials, A/R aging and payer trends, with the items that need a decision from you called out at the top.
• Credentialing and payer enrollment — new providers enrolled, revalidations tracked and CAQH profiles kept current by the same company that files your claims.

How We Measure the Revenue Cycle

We report against standard metric definitions so you can compare month to month and hold us to account. The Healthcare Financial Management Association publishes these definitions as its MAP Keys. HFMA publishes the definitions; it does not publish target values for them, and we don’t quote benchmark numbers here. We set targets with you from your own starting point after the assessment.

Stage	What we do	Metric (HFMA MAP Key)	Definition (paraphrased from HFMA)
Claim submission	Scrub every claim against payer and coding edits before it goes out	CL-1 Clean claim rate	Claims that pass the claim-processing edits without any manual intervention, as a share of all claims accepted into the claims tool for billing.
Denial management	Work each denial by root cause and appeal what is recoverable	AR-5 Remittance denial rate	Claims denied on the remittance (actionable denials, including denials of appeals) as a share of all claims remitted.
A/R follow-up	Work open claims by payer and aging bucket	AR-1 Aged A/R as a percentage of total billed A/R	Billed A/R in each aging category, aged from the date of service for physician practices, as a share of total billed A/R. The categories add up to the whole.
Overall A/R	Keep the whole receivable moving, not just the oldest claims	FM-1 Net days in A/R	Net patient A/R divided by average daily net patient service revenue. Note: FM-1 is balance-sheet based — net A/R is after contractual allowances and reserves — so it is not the same number as “days in A/R” pulled from a gross aging report in your PM system.
Payment posting and collections	Post payments, reconcile deposits and recover underpayments	FM-2 Cash collection as a percentage of net patient service revenue	Patient service cash collected in the month divided by average monthly net patient service revenue.
Cost of the cycle	Show what the revenue cycle costs you, our fee included	FM-6 Cost to collect	Total revenue cycle cost divided by total patient service cash collected.
Contract performance	Compare what was paid with what was allowed and follow up the difference	Net collection rate — practice metric, not an HFMA MAP Key	Payments collected divided by charges less contractual adjustments for the same period. Widely used by physician practices, but it is not one of HFMA’s MAP Keys.

Definitions above are paraphrased from HFMA’s MAP Keys. Your monthly report shows each metric, the trend and what we are doing about it.

Credentialing and Billing Under One Roof

A claim is only as good as the enrollment behind it. If a new physician is not yet enrolled with a payer, or not linked to your group, that payer will deny or hold the claim no matter how clean it is, and the practice often finds out weeks later when the denials arrive. Many software-first and AI RCM platforms automate claim edits and follow-up but don’t do payer enrollment; that work goes back to your office or to a separate vendor, and the two sides rarely talk.

At AMS, credentialing and billing sit in the same company. When you add a provider, we start enrollment with Medicare, Medicaid and your commercial payers before the first claims are due, and the billing team knows each provider’s enrollment status before their claims go out. Revalidations and CAQH attestations run on the same calendar. See our credentialing and provider enrollment services.

Revenue Cycle Management for Texas and DFW Physician Groups

Texas practices face a few things other states don’t. CMS’s WISeR model adds prior authorization for selected services in traditional Medicare in six states, Texas included, from January 1, 2026 through December 31, 2031 (CMS WISeR model page; see our WISeR guide for Texas practices). Texas Medicaid claims run through TMHP and through the state’s Medicaid managed care plans, each with its own enrollment, prior authorization and claim rules, so a group that sees Medicaid patients has to keep enrollment and billing edits current plan by plan.

Multi-specialty groups in Dallas–Fort Worth add another layer: different fee schedules, modifiers and payer rules by department, often under one tax ID. We manage that as one revenue cycle with reporting by location, provider and specialty. More on medical billing services in Texas, medical billing in Dallas and Texas credentialing and provider enrollment.

RCM by Specialty

The stages are the same across specialties; the places where money leaks are not. We staff each account with coders and billers who know your specialty’s payer rules.

Cardiology

Prior authorization for imaging and procedures, global periods on interventional work, and professional and technical components billed across office and hospital settings. See cardiology medical billing.

OB/GYN

Global obstetric packages, split billing when a patient changes practices mid-pregnancy, and preventive and problem-oriented visits on the same day. See OB/GYN medical billing.

Neurology

EEG, EMG and nerve conduction studies, infusion drugs, and prior authorization for advanced imaging and specialty medications. See neurology medical billing.

Sleep Medicine

Home and in-lab sleep studies, medical-necessity documentation, prior authorization and the follow-up visits payers expect for PAP therapy. See sleep medicine billing.

Mental Health

Time-based psychotherapy and evaluation services, telehealth rules that differ by payer, and plans that carve behavioral health out to a separate manager with its own enrollment. See mental health billing.

Family Practice

High visit volume with small balances, preventive and sick visits on the same day, chronic care management and add-on codes that are easy to miss. See family practice medical billing.

Internal Medicine

E/M level support, Medicare annual wellness visits, chronic care management and transitional care after a hospital stay. See internal medicine billing.

What Changes on January 1, 2027

Three federal changes affect physician revenue cycles over the next year. We track them for every client and adjust workflows before they bite.

• Prior authorization APIs (CMS-0057-F). Since January 1, 2026, impacted payers — Medicare Advantage organizations, Medicaid and CHIP programs and their managed care plans, and QHP issuers on the federal exchanges — have had to meet operational prior authorization rules: decisions within 72 hours for expedited requests and seven calendar days for standard requests (QHP issuers on the federal exchanges excluded from those timeframes), and a specific reason when a request is denied. The API requirements, including a Prior Authorization API, generally apply from January 1, 2027 (CMS fact sheet).
• Same-day E/M and global procedures (proposed). In the calendar-year 2027 Physician Fee Schedule proposed rule, CMS proposes that when a separately identifiable office or outpatient E/M visit is furnished by the same physician or group on the same day as a 0-, 10- or 90-day global procedure, the most expensive service would be paid at 100 percent and the others at 50 percent (Federal Register 2026-14327). This is a proposal; the final rule is pending. Procedure-heavy specialties should know how often they bill an E/M with a minor procedure today.
• WISeR continues through 2031. The WISeR prior authorization model runs through December 31, 2031 in its six states, including Texas (CMS).

For the detail on payer timelines, read our guide to the CMS prior authorization rules.

Accounts Receivable and Denial Management

If your biggest problem today is old A/R rather than the whole cycle, we can start there. Our medical accounts receivable services take over aged claims by payer and aging bucket, rework denials and recover underpayments. For a closer look at how we prevent and work denials, see our guide to denial management.

Frequently Asked Questions

What’s the difference between medical billing and revenue cycle management?

Medical billing is the claims part of the cycle: coding, submitting claims, posting payments and following up on unpaid claims. Revenue cycle management covers the whole path from eligibility checks and provider enrollment through denial prevention, A/R, patient balances and reporting. If you only need the claims work, see our medical billing services.

Do you work in our current EHR?

Yes. We work inside your existing practice management and EHR system. There is no software to switch and no data migration; we get user access and work in your system alongside your staff.

Do you handle credentialing?

Yes. Credentialing and payer enrollment are handled by the same company that files your claims, so enrollment for a new provider starts before their first claims and the billing team knows where each application stands.

How is RCM priced?

As a percentage of collections, set out in writing after a free assessment of your current revenue cycle.

Where do you work with practices?

AMS Solutions, Inc. was physician-founded in 1992 and works with practices in all 50 states. Every practice gets a dedicated account representative, coding is reviewed by AAPC-certified coders (CPC/CPB), and we work under a signed BAA.

Ready to see where your revenue cycle is losing money? Start with a free revenue cycle assessment.