Services
RivoRev RCM manages the billing work that keeps your practice paid, so your clinicians can stay focused on patients. We work inside your systems, follow payer rules closely, and report back in plain language. Every service below can be provided on its own or as part of a complete revenue cycle solution.
Eligibility and Benefits Verification
What this includes
- Active coverage and plan type confirmation
- Copay, coinsurance and deductible details
- Authorization and referral requirements flagged
- Coordination of benefits issues identified
Prior Authorisation Management
Procedures and higher-cost services often need payer approval first. We prepare, submit and track authorization requests so approvals are in place before the date of service.
What this includes
- • Collection of the clinical documentation payers require
- • Submission through payer portals or by fax, depending on the payer
- • Status tracking and follow-up until a decision is received
- • Authorization numbers and approved units recorded so they match the claim
Charge Capture and Coding Review
Accurate claims depend on documentation that supports what was billed. We review encounters for missing charges, incomplete notes and coding mismatches before claims are released.
What this includes
- • Comparison of documentation against the services and diagnoses reported
- • Review of CPT, HCPCS and ICD-10-CM code selection and modifier use
- • Queries sent to providers when documentation is unclear
- • Feedback on recurring documentation gaps so they can be fixed at the source
Claim Scrubbing and Submission
A clean claim gets paid faster. Each claim is checked against payer edits and formatting requirements before it is sent, and rejections are worked the same day they are returned.
What this includes
- • Pre-submission checks for demographic, coverage and coding errors
- • Electronic submission through your clearinghouse
- • Timely handling of clearinghouse and payer rejections
- • Tracking of filing deadlines so claims are not lost to timely filing limits
Payment Posting and Reconciliation
Posting is where underpayments and errors are easiest to catch. We post payments, adjustments and denials accurately and compare them against expected reimbursement.
What this includes
- • Electronic remittance (ERA/EOB) posting by payer and claim
- • Contractual adjustments and patient responsibility posted correctly
- • Underpayments and incorrect allowed amounts flagged for follow-up
- • Deposits reconciled against what was posted
Denial Management and Appeals
A denial is a signal, not just a setback. We find out why claims were denied, correct and resubmit where possible, appeal where it is worth the effort, and look for patterns that point to a fixable cause.
What this includes
- • Denials categorized by reason code and root cause
- • Corrected claims and appeals prepared with supporting documentation
- • Payer-specific appeal timelines tracked
- • Monthly denial trend summaries with recommended process fixes
Accounts Receivable Follow-Up
Unpaid claims lose value as they age. We work open balances in priority order, so older and highervalue claims get attention first.
What this includes
- • Aging buckets reviewed on a regular schedule
- • Payer follow-up by portal, phone or written inquiry
- • Claims that stall without a response escalated
- • Clear notes on every account so nothing is worked twice
Patient Billing Support
Patient balances need a clear and respectful process. We help prepare accurate statements and handle routine billing questions in line with your practice policies.
What this includes
- • Patient balances identified after insurance processing
- • Statements prepared using the format and timing your practice approves
- • Routine billing questions handled, with clinical or policy questions routed back to your team
- • Payment plan and self-pay workflows followed as your practice defines them
Reporting and Performance Insight
You should always know where your revenue stands. We provide regular reports in plain language, built around the numbers that help you make decisions.
What this includes
- • Charges, payments, adjustments and outstanding balances
- • Days in A/R and aging by payer
- • Denial rates and top denial reasons
- • Recommendations tied to what the numbers show
RivoRev RCM is a health-care revenue cycle management company that helps providers optimize billing, coding, and collections.
We partner with providers to combine industry expertise, technology, and data-driven processes to reduce revenue leakage and improve financial performance.
Poolangudi, Trichy, Tamil Nadu, India – 620025