Most medical practices lose 3-5% of potential revenue to billing errors, denied claims, and administrative inefficiencies. Nexus io’s healthcare revenue cycle management services address these losses through AI automation and specialized expertise. We offer end-to-end RCM services starting from patient registration through final reimbursement.
The challenge isn’t just processing claims faster; it’s processing them correctly the first time. That’s where our specialty-specific coding teams and AI-powered claim scrubbing make the difference. When a claim does get denied, our system flags it within hours, not weeks, and routes it to specialists who know exactly which documentation payers need to reverse their decision.
Collection Ratio
First Pass Clean Claim Rate
Reduction in A/R
Most practices don’t have a revenue problem; instead, they have a revenue capture problem. Between coding errors, denied claims, and administrative bottlenecks, the average medical practice loses 3-5% of potential revenue before it ever reaches its bank account.
Medical revenue cycle management efficiency is about getting paid the first time correctly. Nexus io’s healthcare RCM solutions handle the entire financial journey, starting from the moment a patient schedules an appointment through the final payment posting. We have one goal: eliminating the gaps where your revenue disappears.
Our approach combines something most healthcare RCM companies can’t: certified coders who actually understand your specialty, paired with AI-powered technology. We maintain 98% coding accuracy across specialties, which translates to 40% fewer denials and cash flow that arrives 25-30 days faster than industry averages.
What you gain with our end-to-end revenue cycle management:
Coding Accuracy Rate
Revenue Growth
States Served
Clean Claim Rate
The revenue cycle breaks down in predictable places, and most practices don’t realize it until the damage compounds. Insurance verification happens too late, catching coverage issues after services are rendered. Claims sit in queues for weeks because your billing staff is underwater.
The reality is that 15-20% of claims get denied on first submission across the industry. For many medical practices, half of those denials never get appealed because staff simply don’t have the bandwidth.
Healthcare RCM solutions from Nexus io address these systemic failures through intelligent automation and proactive management. Our platform flags insurance eligibility issues before appointments, not after. We scrub claims against payer-specific edits before submission, catching the rejections that would typically cost you 30-45 days in delays.
When denials do occur, our specialists analyze root causes across your entire claim volume, identifying whether you’re dealing with coding issues, documentation gaps, or payer-specific quirks. Then we fix the underlying problem, not just the individual claim.
Nexus io eliminates the 6–9-month cycle of recruiting, hiring, and training billing staff. Our team includes AAPC and AHIMA-certified coders who specialize in your exact clinical area, including cardiology, orthopedics, or multi-specialty practice management.
These specialists understand specialty-specific coding requirements and ensure that complex procedures receive accurate code assignments and proper documentation support. With us, you avoid the costly learning curve associated with training new employees on specialty-specific coding nuances and payer requirements.
Our HIPAA-compliant platform uses end-to-end encryption, role-based access controls, and regular security audits that meet federal requirements. Every team member completes rigorous HIPAA training and recertification annually.
We maintain detailed audit trails for all data access. Our security infrastructure includes secure data transmission protocols, encrypted storage systems, and continuous monitoring for potential vulnerabilities.
Your current billing operation carries hidden costs: salaries during slow months, overtime during busy periods, recruiting fees when staff leave, and ongoing training for regulation changes. Nexus io’s medical RCM services convert these unpredictable expenses into fixed monthly investments tied directly to your claims volume.
Our pricing scales directly with your actual claims volume. This transparent pricing model allows healthcare administrators to forecast revenue cycle costs accurately. You don’t get any surprise expenses and can allocate resources more strategically.
The Nexus io platform delivers AI-powered claim scrubbing, real-time payer eligibility verification, and automated denial tracking. Our cloud-based system integrates seamlessly with major practice management systems and electronic health records, so you can access sophisticated revenue cycle tools immediately without IT projects or infrastructure upgrades.
Our intuitive dashboard provides real-time visibility into key performance metrics, claim status updates, and denial patterns. Healthcare administrators make data-driven decisions that optimize revenue capture and accelerate payment cycles.
CMS releases coding updates quarterly. Major payers modify submission requirements monthly. State regulations evolve continuously. Nexus io’s compliance team monitors these changes across all 50 states and hundreds of payer networks, updating our systems before new rules take effect. This proactive approach ensures your claims remain compliant automatically.
Our compliance infrastructure protects healthcare organizations from costly penalties. We reduce claim rejection rates and maintain smooth revenue flow despite the increasingly complex regulatory environment governing medical billing and reimbursement.
Adding providers typically means expanding your billing team, equipment, and office space. With Nexus io’s RCM services for healthcare providers, your revenue cycle infrastructure scales instantly. Acquiring a new practice? We absorb their claim volume within days. Opening a satellite location? Our systems support it without additional overhead.
This scalability advantage allows healthcare organizations to pursue growth opportunities confidently. Your revenue cycle management capabilities expand seamlessly alongside your clinical operations.
Nexus io eliminates the 6–9 month cycle of recruiting, hiring, and training billing staff. Our team includes AAPC and AHIMA-certified coders who specialize in your exact clinical area, including cardiology, orthopedics, or multi-specialty practice management.
Our HIPAA-compliant platform uses end-to-end encryption, role-based access controls, and regular security audits that meet federal requirements. Every team member completes rigorous HIPAA training and recertification annually.
Your current billing operation carries hidden costs: salaries during slow months, overtime during busy periods, recruiting fees when staff leave, and ongoing training for regulation changes. Nexus io’s medical RCM services convert these unpredictable expenses into fixed monthly investments tied directly to your claims volume.
The Nexus io platform delivers AI-powered claim scrubbing, real-time payer eligibility verification, and automated denial tracking. Our cloud-based system integrates seamlessly with major practice management systems and electronic health records, so you can access sophisticated revenue cycle tools immediately without IT projects or infrastructure upgrades.
CMS releases coding updates quarterly. Major payers modify submission requirements monthly. State regulations evolve continuously. Nexus io’s compliance team monitors these changes across all 50 states and hundreds of payer networks, updating our systems before new rules take effect. Your claims stay compliant automatically.
Adding providers typically means expanding your billing team, equipment, and office space. With Nexus io’s RCM services for healthcare providers, your revenue cycle infrastructure scales instantly. Acquiring a new practice? We absorb their claim volume within days. Opening a satellite location? Our systems support it without additional overhead.
Nexus io works tirelessly to diagnose what’s breaking your revenue cycle and fix it systematically. While other healthcare revenue cycle management companies offer generic solutions, we’ve built our platform around a simple truth: every specialty has different payer relationships, coding complexities, and reimbursement challenges.
Our medical RCM services combine specialty-specific intelligence with technology that most practices can’t access independently. We’ve processed over 2 million claims across 40+ specialties, which means when a payer suddenly changes their documentation requirements for a specific CPT code, we’ve likely already solved it for another client. That institutional knowledge translates directly into faster resolutions and fewer revenue disruptions for your practice.
What you gain with Nexus io’s healthcare revenue cycle management solutions:
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Numbers tell the story better than promises. Here’s what happened when a multi-provider internal medicine practice switched from in-house billing to Nexus io’s healthcare revenue cycle management services:
| Metric | In-House Billing | Nexus io RCM | Results |
|---|---|---|---|
| Charges (monthly average) | $147,200 | $147,200 | — |
| Gross Collection Rate | $59,735 (40.6%) | $77,650 (52.8%) | 12.2% Increase in Collections |
| Monthly Billing Costs | $5,980 | $4,350 | $1,630 Cost Reduction |
| Yearly Net Benefit | — | $214,980 | ≈32% Overall Revenue Increase |
Our cloud-based technology handles the complexity so your team doesn’t have to. Here’s what separates Nexus io’s RCM services for healthcare providers from basic billing companies
Most practices verify insurance when patients arrive and discover coverage problems after services are rendered. Nexus io’s automated system checks eligibility 48 hours before scheduled appointments, flagging issues while you still have options
Prior authorization delays kill practice productivity and patient satisfaction. Nexus io’s authorization workflow tracks requirements across hundreds of payer policies, automatically identifying which procedures need approval before you schedule them
Manual payment posting consumes hours and introduces errors that cascade through your accounts receivable. Nexus io’s automated posting system processes ERA files instantly, matching payments to claims, identifying underpayments, and flagging discrepancies that require investigation
Paper statements cost $2-3 each to print and mail. Most patients ignore the first two statements, delaying payment by 60+ days. Nexus io’s patient financial services approach reduces costs while accelerating collections
Month-end reports tell you what happened weeks ago. Nexus io’s dashboards show what’s happening right now, enabling immediate action instead of delayed reactions. Productivity metrics track claim submission speed, appeal turnaround, and payment posting efficiency. You spot problems when they emerge, not after they’ve cost you a quarter’s worth of lost revenue.
Generic reports show everyone the same data. Nexus io’s BI tools adapt to what you actually need to know. Our clients use these insights to renegotiate payer contracts, adjust scheduling strategies, and make informed decisions about practice expansion using data, not gut feelings.
Our team captures complete demographic information, validates insurance coverage in real-time, and identifies potential payment issues 48 hours before scheduled appointments.
Once clinical documentation is complete, our AAPC and AHIMA-certified coders translate your services into precise ICD-11 and CPT codes that reflect the medical necessity of care provided.
After code assignment, our billing specialists translate those codes into claims that meet each payer’s specific formatting, documentation, and submission requirements.
Before any claim leaves our system,
it passes through AI-powered scrubbing that checks against
50+ payer-specific rule sets.
Once quality validation completes, claims move to electronic submission within 24-48 hours. Our healthcare RCM solutions track every claim from submission through adjudication.
When payers remit, our system automatically posts payments, matches them to submitted claims, calculates patient balances, and flags discrepancies that require investigation.
Our denial management specialists analyze the rejection reason, review your payer contract, and determine whether the appeal will succeed based on the documentation.
Our A/R team segments receivables by payer type, claim age, and dollar value, then applies appropriate collection strategies to each category.
Nexus io’s real-time dashboards show what’s happening now, enabling immediate course corrections instead of discovering problems after they’ve compounded.
Our team captures complete demographic information, validates insurance coverage in real-time, and identifies potential payment issues 48 hours before scheduled appointments.
Once clinical documentation is complete, our AAPC and AHIMA-certified coders translate your services into precise ICD-11 and CPT codes that reflect the medical necessity of care provided.
After code assignment, our billing specialists translate those codes into claims that meet each payer’s specific formatting, documentation, and submission requirements.
Before any claim leaves our system,
it passes through AI-powered scrubbing that checks against
50+ payer-specific rule sets.
Once quality validation completes, claims move to electronic submission within 24-48 hours. Our healthcare RCM solutions track every claim from submission through adjudication.
When payers remit, our system automatically posts payments, matches them to submitted claims, calculates patient balances, and flags discrepancies that require investigation.
Our denial management specialists analyze the rejection reason, review your payer contract, and determine whether the appeal will succeed based on the documentation.
Our A/R team segments receivables by payer type, claim age, and dollar value, then applies appropriate collection strategies to each category.
Nexus io’s real-time dashboards show what’s happening now, enabling immediate course corrections instead of discovering problems after they’ve compounded.
Revenue cycle success starts before the patient walks through your door. Our team captures complete demographic information, validates insurance coverage in real-time, and identifies potential payment issues 48 hours before scheduled appointments. When prior authorization is required but hasn’t been obtained, we alert you with time to fix it.
This front-end precision prevents 60-70% of the payment problems that typically surface after services are rendered, when your options for correction have evaporated.
Once clinical documentation is complete, our AAPC and AHIMA-certified coders translate your services into precise ICD-10, ICD-11 codes and CPT codes that reflect the complexity and medical necessity of care provided.
Our coders don’t just assign codes; they analyze documentation for completeness, identify opportunities to capture higher levels of service when justified, and ensure every diagnosis supports the procedures billed. This is where 98% coding accuracy comes from.
After code assignment, our billing specialists translate those codes into claims that meet each payer’s specific formatting, documentation, and submission requirements. We apply payer-specific fee schedules, verify that modifiers align with payer policies, confirm that units billed match documentation, and ensure supporting documents attach when required.
Before any claim leaves our system, it passes through AI-powered scrubbing that checks against 50+ payer-specific rule sets, then receives human review from quality assurance specialists who catch any algorithms that miss.
Our QA team verifies that diagnosis codes support procedures performed, confirms modifiers comply with current CMS guidelines, validates that code combinations won’t trigger bundling edits, and checks that documentation meets medical necessity standards for the services billed. This dual-layer review—technology plus expertise—pushes clean-claim rates above 96%.
Once quality validation completes, claims move to electronic submission within 24-48 hours. We route claims through clearinghouses that perform additional scrubbing, then transmit to payers using their preferred formats and channels.
Our healthcare RCM solutions track every claim from submission through adjudication. If a payer’s system rejects a claim electronically before human review, we catch it immediately and resubmit with corrections.
When payers remit, our system automatically posts payments, matches them to submitted claims, calculates patient balances, and flags discrepancies that require investigation. Manual posting takes 3-5 minutes per remittance. Our automation completes it in seconds while maintaining higher accuracy.
We verify that payers applied contracted rates correctly, identify underpayments that warrant appeals, and ensure every adjustment code makes sense given your payer agreements.
Denied claims trigger immediate triage in our system. Our denial management specialists analyze the rejection reason, review your payer contract, and determine whether the appeal will succeed based on the documentation available and payer policies.
Our appeal success rate averages 65-70% because we don’t waste effort on low-probability cases. We focus resources where recovery is likely, maximizing return on the time invested in appeals.
Every day a claim sits unpaid, its collection probability drops. Our A/R team segments receivables by payer type, claim age, and dollar value, then applies appropriate collection strategies to each category.
High-dollar claims get priority attention. Claims approaching timely filing deadlines receive urgent follow-up. Payers with consistent payment delays face escalated outreach. This intelligence-driven approach typically reduces days in A/R by 25-35% within the first quarter, converting stale receivables into working capital your practice can actually use.
Month-end financial reports tell you what happened weeks ago. Nexus io’s real-time dashboards show what’s happening now, enabling immediate course corrections instead of discovering problems after they’ve compounded.
Our analytics track key performance indicators that matter: clean-claim rates by payer and provider, denial rates by reason code, days in A/R by age bucket, collection rates compared to charges submitted, and trends that indicate emerging issues before they become expensive problems.
At Nexus io, we understand that every medical specialty presents unique payment posting challenges. That’s why our expert team is available 24/7 to deliver accurate, timely, and specialty-specific posting services tailored to your practice’s needs.
Whether you’re dealing with high-volume claims, complex reimbursements, or specialty-specific coding, our round-the-clock support ensures every payment is properly recorded and reconciled—helping you maintain financial accuracy, reduce denials, and improve revenue cycle performance.
Our achievements are a testament to our hard work team to deliver exceptional revenue boost results and gain the client’s trust in us.
What is revenue cycle management in healthcare?
Revenue cycle management tracks your practice’s finances from appointment scheduling through final payment collection. Effective medical billing and RCM services connect registration, coding, claims, and collections into one system so money doesn’t leak out between departments.
Why should practices consider RCM outsourcing for healthcare?
RCM outsourcing for healthcare eliminates the endless cycle of hiring, training, and replacing billing staff while giving you access to technology that costs $100K+ to build in-house. You get predictable monthly costs and specialists who track payer changes full-time—something your small billing team can’t do while processing thousands of claims.
What's the difference between physician practice and hospital revenue cycle management?
Physician practice revenue cycle management handles straightforward office billing—visits, outpatient procedures, and standard coding scenarios. Hospital revenue cycle management tackles more complexity exponentially: inpatient stays with specialized procedure codes, DRG optimization, case mix reporting, and Medicare regulations that most outpatient billers never encounter.
How do I choose the right healthcare revenue cycle management company?
Look for a healthcare revenue cycle management company that shows actual performance data—their clean-claim rates, A/R reduction timelines, and denial rates with current clients in your specialty. Make sure their technology integrates with your existing systems, and they provide real-time dashboards, not just monthly reports you can’t act on.
What should healthcare revenue cycle management solutions include?
Complete healthcare revenue cycle management solutions should cover everything from insurance verification before appointments through final patient collections, with no gaps where revenue disappears. If you’re managing handoffs between separate coding vendors, billing companies, and collection agencies, you’re losing money in the transitions.
Your practice deserves financial operations that work as hard as you do. Nexus io’s specialists are ready to analyze your current revenue cycle, identify specific improvement opportunities, and show you exactly what performance gains look like in your first 90 days.
Connect with our revenue cycle experts today to discuss your practice’s unique challenges and discover how our end-to-end solutions can eliminate administrative burden while increasing profitability.
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