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Revenue Performance Company

Turn revenue complexity into performance.

PremiumRCM combines revenue cycle expertise, specialty knowledge and operational discipline — with reporting that shows leadership exactly where revenue is captured, delayed or lost.

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First-pass clean claims
98.4%
A/R over 90 days
11.2%
Specialties supported
30+

Net collections

$14.8M

+12.4% YoY

Days in A/R

28

−9 days

Denial rate

4.1%

−5.2 pts

Clean claim rate98.4%

Platform capabilities & specialties served

  • Medical
  • Dental & DSO
  • FQHC
  • Behavioral Health
  • IVF & Fertility
  • CCM · RPM · TCM · AWV
  • Credentialing
  • Telehealth

03 · Where revenue leaks

Every dollar has six chances to go missing.

Select a stage to see the failure pattern we look for first, and the control we put in place.

Stage 01 · Patient access

Coverage problems are cheapest to fix before the visit.

Most downstream denials are decided at scheduling. We verify coverage, benefit limits and authorization requirements up front, and flag the encounters that need attention before the patient arrives.

  • Real-time verification
  • Benefit limit review
  • Front-desk exception queue
  • Eligibility-driven denials ↓ 41%
  • Verified before visit 97%
  • Auth exceptions caught 2.1k

Stage 02 · Coding

Underspecified documentation quietly discounts every claim.

Certified coders review specialty-specific documentation patterns, correct modifier and specificity gaps, and route recurring issues back to the provider as short, concrete feedback.

  • Specialty coding review
  • Modifier audit
  • Provider feedback loop
  • Coding accuracy 98.6%
  • Charge lag 1.3 days
  • Documentation queries ↓ 33%

Stage 03 · Claims

A claim that scrubs clean the first time is the cheapest claim you will ever file.

Charges are captured, scrubbed against payer-specific edits and submitted daily. Rejections are worked the same day rather than aging in a clearinghouse report nobody opens.

  • Payer-specific edits
  • Daily submission
  • Same-day rejection work
  • First-pass clean claims 98.4%
  • Rejections aged >2d 0.4%
  • Submission cadence Daily

Stage 04 · Denials

We treat denials as a process defect, not a workload.

Every denial is coded to a root cause, appealed on a defined clock, and fed back into eligibility, coding or submission rules so the same denial does not return next month.

  • Root-cause coding
  • Appeal SLA
  • Prevention rules
  • Denial overturn rate 72%
  • Repeat denial causes ↓ 38%
  • Days to appeal 4.2

Stage 05 · A/R

Aging buckets are worked on a schedule, oldest money first.

Insurance follow-up, underpayment detection and recovery run on a disciplined queue with documented touch history — so nothing sits at 90+ days because it was awkward to call.

  • Aged A/R queue
  • Underpayment recovery
  • Documented touch history
  • A/R over 90 days 11.2%
  • Days in A/R 28
  • Underpayments recovered $412k

Stage 06 · Payment

Posting accuracy is what makes every other number trustworthy.

Payments and adjustments are posted promptly and reconciled against expected reimbursement, with clear patient statements and a billing support path that does not damage the relationship.

  • Expected-vs-paid reconciliation
  • Clear statements
  • Patient billing support
  • Posting within 24h 99%
  • Patient collection rate 86%
  • Statement disputes ↓ 27%

04 · What PremiumRCM does

Ten disciplines, run as one accountable operation.

All services
01

Revenue Cycle Management

End-to-end ownership from patient access through payment posting, with workflow redesign where it measurably pays. Full RCM · Workflow optimization · Billing operations 02

Claims

Daily charge capture and submission against payer-specific edits, with rejections worked the same day. Charge capture · Submission · Status · Payment posting 03

Denial Management

Denials coded to root cause, appealed on a clock, then converted into prevention rules upstream. Prevention · Root cause · Appeals · Rework 04

A/R Management

Aged balances worked oldest-money-first with documented touch history and underpayment recovery. A/R aging · Insurance follow-up · Underpayments · Recovery 05

Coding

Specialty-accurate medical and dental coding, with documentation feedback that changes provider behaviour. Medical · Dental · Coding review · Documentation support 06

Patient Access

Coverage certainty before the encounter: eligibility, benefit limits, prior authorization and clean registration. Eligibility · Benefits · Prior auth · Registration 07

Credentialing & Enrollment

Credentialing, payer enrollment, revalidation and CAQH maintenance so billing is never blocked. Credentialing · Enrollment · Recredentialing · CAQH 08

Patient Billing

Statements patients can read, plus support that collects balances without damaging the relationship. Statements · Balances · Billing support · Workflow 09

Reporting & Analytics

Executive dashboards for collections, payer performance, denial trends and A/R — traceable to the claim. Dashboards · Payer performance · Denial trends · A/R analytics 10

Care Management Billing

Time tracking, eligibility and documentation support for longitudinal and remote care revenue. CCM · RPM · TCM · AWV · Care coordination

05 · Solutions by organization

Built for how your organization actually bills.

Solo Practice

1 provider

One point of accountability for billing, follow-up and reporting — without hiring a back office.

Solo practice billing →

Group Practice

2–50 providers

Consistent coding and follow-up across providers, with per-provider performance visibility.

Group practice RCM →

Dental & DSO

Multi-location

Dental coding, eligibility and A/R with location-level reporting and DSO workflows.

Dental & DSO billing →

FQHC & Community Health

Multi-site

Wraparound and payer complexity handled with clean reporting for boards and funders.

FQHC billing →

Behavioral Health

Auth-heavy

Authorization tracking, session-based billing and telehealth rules across payers.

Behavioral health billing →

Multi-Location Groups

Enterprise

Standardized workflows with roll-up and site-by-site revenue comparison.

Multi-location RCM →

06 · Specialty intelligence

Specialty revenue problems are not the same problem.

Each category is a dedicated landing page with its own copy, imagery, FAQs and CTA — added from the specialty data model, never redesigned.

IVF & Fertility

IVF & Fertility

Benefit verification, cycle authorization and self-pay balances — its own landing page, not a line under OB/GYN.

IVF & fertility billing →

Dental & DSO

Dental & DSO

Dental coding, plan limits, pre-determinations and multi-location A/R.

Dental billing →

FQHC & Community Health

FQHC & Community Health

Encounter-rate billing, payer mix complexity and multi-site reporting.

FQHC billing →

Behavioral Health

Behavioral Health

Psychiatry, counseling, ABA and telebehavioral authorization workflows.

Behavioral health billing →

Surgical & Procedural

Surgical & Procedural

Global periods, assistant-surgeon rules, implants and prior authorization.

Surgical billing →

CCM · RPM · TCM · AWV

CCM · RPM · TCM · AWV

Time tracking, eligibility and documentation for care-management revenue.

Care management billing →

  • Cardiology
  • GI
  • Neurology
  • Nephrology
  • Oncology
  • Urology
  • Dermatology
  • Ophthalmology
  • ENT
  • Podiatry
  • PT / OT / Speech
  • Chiropractic
  • Pain Management
  • Women's Health
  • Pediatrics
  • Urgent Care
  • Home Health
  • Hospice
  • Skilled Nursing
  • Telehealth

07 · Performance reporting

Reporting your leadership team can act on.

Collections, clean-claim performance, A/R aging, denial root causes and payer behaviour — reviewed on a fixed cadence, not sent as a PDF and forgotten.

  • Monthly performance review with a named RCM lead, not a ticket queue.
  • Denial root-cause reporting that names the payer, the code and the fix.
  • Per-provider and per-location comparison for multi-site organizations.
  • Every figure traceable back to the claim it came from.

Net collections · trailing 12 months

$14.8M+12.4% YoY

Expected vs. collected reconciled monthly

Net collection rate
97.1%
Avg. reimbursement / encounter
$186
Charge lag
1.3 days

First-pass clean claim rate

98.4%+3.1 pts

Scrubbed against payer-specific edits

Rejections worked same day
96%
Edits maintained
1,240
Resubmission rate
1.6%

A/R over 90 days

11.2%−9.6 pts

Oldest balances worked first

Days in A/R
28
Touches per aged claim
3.4
Recovered this year
$412k

Denial rate by root cause

4.1%−5.2 pts

Every denial coded to a root cause

Overturn rate
72%
Days to appeal
4.2
Prevention rules added
68

08 · How we work

A loop, not a handoff.

  1. 01

    Discover

    Current workflow, payer mix, systems and where money stalls today.

  2. 02

    Analyze

    Baseline clean-claim rate, denial concentration and A/R aging.

  3. 03

    Optimize

    Rewrite the workflow steps causing the largest measured loss.

  4. 04

    Execute

    Run daily operations against defined SLAs and queues.

  5. 05

    Report

    Fixed-cadence executive reporting with named owners.

  6. 06

    Improve

    Feed findings back into rules so the same leak does not return.

09 · Why PremiumRCM

Discipline is the differentiator.

  1. 01

    A named team, not a queue

    You know who works your account and who to call when something changes.

  2. 02

    Specialty knowledge

    Coding and payer rules that reflect your specialty, from dental limits to IVF cycles.

  3. 03

    Real visibility

    Reporting that shows where revenue is captured, delayed or lost — down to the claim.

  4. 04

    Disciplined follow-up

    Aged A/R and appeals worked on a clock, with documented touch history.

10 · Proof PLACEHOLDER — VERIFY BEFORE PUBLISH

Problem → intervention → result.

Placeholder · Multi-location dental group Placeholder

Problem
38% of A/R past 90 days across six locations.
Intervention
Aged A/R queue, eligibility rework, per-site reporting.
Result
A/R >90 days to 12% in 7 months

Placeholder · Behavioral health practice Placeholder

Problem
Authorization denials on 1 in 5 telehealth sessions.
Intervention
Auth tracking, payer rule matrix, appeal SLA.
Result
Denial rate 19% → 4.6%

Placeholder · FQHC, four sites Placeholder

Problem
Board reporting rebuilt by hand each month.
Intervention
Standardized encounter reporting and reconciliation.
Result
6 days of manual work removed

11 · Resources

Executive reading, not blog filler.

Guide

The six places practice revenue actually leaks

A stage-by-stage audit checklist for eligibility through payment posting.

Analysis

Reading payer behaviour from your own denial data

How to turn denial codes into a prevention roadmap your team can act on.

Checklist

Specialty billing readiness: dental, FQHC, behavioral, IVF

What to verify before you accept a new payer contract or open a new site.

Next step

Request a Revenue Performance Review.

A structured read of your current performance: clean-claim rate, denial concentration, A/R aging and the three workflow changes with the largest revenue impact.

586-371-2959

Request Revenue Performance Review