Experience Faster Claims and Smarter Revenue!
Full-service Revenue Cycle Management for solo practices, group practices, and hospitalist groups. Our clients average a 96% net collection rate and we maintain an 83% clean claims rate across every practice we serve.
96%
Avg. net collection rate
83%
Clean claims rate
94%
NCR via denial mgmt
100%
Client retention
U.S. healthcare billing systems are built to underpay, Here is what the data says and how we fix it
Denied claims at most practices are never resubmitted to payers and the money is written off permanently.
- Every denied, rejected, or partially paid claim is assigned to a dedicated Denial Analyst who works it until paid, achieving a Net Collection Rate of 94%.
Average underpayment by payers on contracted rates across U.S. practices. Most providers never catch it without regular fee schedule audits.
- We run periodic fee schedule audits to confirm payers are honoring contracted rates and recover shortfalls.
Claims are not paid on first submission, and 10% are lost entirely and never reach a payer due to clearinghouse management failures.
- Every claim is audited for ICD/CPT compatibility before submission. We maintain an 83% clean claims rate.
What eClaimWorks Delivers for Your Practice
Built to Serve Practices of Every Size, From Solo to Hospitalist Groups
12+
years serving practices
4+
years minimum experience per biller
40+
years combined RCM experience
- Customized for every practice. RCM services, workflows, and reporting are customized to your specialty and payer mix.
- PM and EHR software included. Advanced Practice Management and Electronic Health Record tools at no additional cost.
- CMRS and CPC certified team. All billers and coders are trained on CMRS and CPC templates, with ongoing updates as regulations evolve.
- Direct physician access. Physicians can schedule time directly with our key RCM staff to resolve issues quickly.
Unique Approach to Healthcare, Makes Us the Best in the RCM Business
360-Degree Support
We specialize in billing and coding for small and mid-sized practices. Physicians can opt for one-to-one meetings with our key personnel to quickly resolve any issue.
Domain Knowledge
Our team holds active CMRS and CPC certifications and undergoes ongoing training on payer policy changes, CMS updates, and coding rule revisions.
Dedicated Teams
A consistent team of experienced professionals manages your account. You also receive front office and EHR tools to handle scheduling, check-in, and patient flow.
Full Service Spectrum
Credentialing, eligibility alerts, patient balance alerts, AWE alerts, MIPS & PQRS assistance the complete spectrum of RCM services that makes your practice successful.
End-to-End Revenue Cycle Management
Practice Financial Analysis
Identify revenue leaks, assess payer performance, and make data-driven decisions with in-depth financial reporting.
- Aging AR - Insurance & Patient
- Days in AR & Clean Claim Ratio
- Denial rate & trend analysis
- Insurance fee schedule review & audit
Practice Setup and Credentialing
Get paneled and billing faster. We handle all enrollment and operational groundwork so you can focus on patients from day one.
- Provider enrollment & credentialing
- EHR, PM & clearinghouse setup
- NCCI coding compliance audit
- Workflow & process documentation
Pre-Billing and Eligibility
Prevent denials before they happen with rigorous eligibility checks, prior auth management, and patient reminders.
- Insurance eligibility & benefit verification
- AWE (Advance Warning Event) alerts
- Pre-authorization & referral management
- Patient balance reminders
Billing and Claims Management
Every claim scrubbed, submitted, and tracked. Our internal audit process validates ICD/CPT compatibility per CMS guidelines before every submission.
- Claim scrubbing & ICD/CPT audit
- Electronic & manual claim submission
- Clearinghouse edits & rejection management
- Denial management & appeals (1st, 2nd, ext)
- Payment reconciliation & underpayment recovery
AR Management and Denial Analysis
The crux of our work begins once we post the claim. Dedicated Denial Analysts pursue every 90+ day bucket and every appeal level until you're paid.
- Specialized Denial Analyst team
- AR tracking across all aging buckets
- Periodic coding audit to prevent downcoding
- Patient statement dispatch & follow-up
- Collection agency coordination
MIPS, PQRS, and Compliance
Navigate value-based care without the headache. We optimize your scores, maximize incentives, and keep you on the right side of CMS reporting requirements.
- Accurate MIPS reporting & CMS submission
- PQRS assistance & incentive maximization
- Performance score optimization
- APM compliance tracking
- Penalty risk monitoring & reduction
Smart Practices Partner With eClaimWorks
- $45,000 to $65,000 per year in salary and benefits for one biller
- Revenue drops every time that person leaves or takes leave
- No benchmarks to assess biller performance
- Ongoing retraining required as payer rules and CMS guidelines change
- No MIPS or PQRS expertise, so penalties accumulate undetected
- 60% of denied claims go unworked and become permanent write-offs
- Performance-based pricing: you pay more only when you collect more
- Continuous coverage with no gaps and no turnover disruptions
- Monthly KPI reporting covering NCR, denial rate, and days in AR
- CMRS and CPC certified team with continuous training
- MIPS, PQRS, and APM support included at no extra cost
- Dedicated Denial Analysts pursue every denied claim to resolution
MIPS Reporting Gaps Can Cost You Up to 9% of Your Medicare Payments
MIPS and PQRS Reporting
Complete data collection and CMS submission, on time, for every reporting window.
Score Optimization
We focus on quality measures that produce the highest improvement to your composite performance score.
Incentive Maximization
We identify every pathway to positive payment adjustments, not just penalty avoidance.
APM Compliance
Full support for Advanced Alternative Payment Model participation requirements.
Three Phases and No Disruption to Your Practice.
Phase 1: Assessment
KEY ACTIVITIES
- Current state process analysis
- AR analysis by CPT and payor
- Denial trend identification
- Coding and compliance audit
MILESTONES
- Meeting with practice owners
- Information request sent
- Ongoing Q and A sessions
YOU RECEIVE
- Practice Analysis presentation
- Performance improvement plan
- 5-Year Practice Roadmap
Phase 2: Initiation
KEY ACTIVITIES
- Process documentation developed
- Legal agreements drafted
- IT access and system setup obtained
- Staff training strategy developed
MILESTONES
- Operational details confirmed
- Legal documents obtained
- Full practice information collected
YOU RECEIVE
- Draft Standard Operating Procedure
- RCM targets established
Phase 3: Implementation
KEY ACTIVITIES
- eClaimWorks assumes full RCM control
- Front-end and back-end optimization
- Target setting and go-live
MILESTONES
- SOP signed
- RCM service live
- Weekly and monthly reporting starts
YOU RECEIVE
- Metrics tracking dashboard
- Customized RCM reports
- Monthly tracking-to-targets calls
What Practices Experience With eClaimWorks
Before You Reach Out
Q. How much does outsourced billing cost?
Our pricing is performance-based, typically a percentage of collections. You pay more only when you collect more. Credentialing, eligibility verification, practice analysis, and coding audits are included at no additional cost. We provide a specific proposal after your free assessment.
Q. Will you work with my current EHR or PM system?
Yes. We integrate with most major EHR and PM platforms. We also provide advanced PM and EHR software at no extra cost for practices that need it.
Q. How long does switching take?
Most practices complete all three onboarding phases and go live within a few weeks. We manage the full transition with no gap in claim submission. Your Practice Analysis presentation is delivered before the process begins.
Q. Is my patient data secure?
Yes. We are fully HIPAA compliant with signed BAAs, enterprise data security, and strict access controls. Patient PHI remains in a compliant, secure environment at all times.
Q. We are a solo practice. Are we too small?
No. Solo practitioners are among our longest-standing clients. Our model is built for cost-effective, high-quality billing for single-provider offices. You receive the same certified team as our larger group clients.
Q. What does the free practice assessment involve?
We review your AR aging by CPT and payor, identify denial trends, assess coding compliance, and deliver a Practice Analysis with specific improvement recommendations and a 5-year Practice Roadmap. There is no commitment required.
