HIPAA-Compliant Revenue Cycle Management for Specialty Healthcare Providers
Primary care billing services and revenue cycle management for outpatient practices where multi-payer complexity and AR ownership gaps keep collections below what visits actually generate.
Most outpatient revenue shortfalls don’t start with billing errors. They start with eligibility checked without full context, payments posted without variance review, and AR follow-up running on a schedule instead of by account priority.
In outpatient settings, revenue issues often start before AR at eligibility interpretation and charge accuracy. Learn how to evaluate if your billing partner is actually performing.
When coverage details, visit types, or payer rules aren’t aligned upfront, billing and AR teams spend months correcting issues that could have been prevented.
Outpatient AR stalls when eligibility gets verified but not interpreted, payer edits get reworked instead of prevented, and follow-up runs on a 30-day cycle instead of by account. We assign ownership at each step before claims go out, not after balances hit 90 days.
Our approach is designed to control revenue from front-end verification through final AR resolution.
We assign ownership before claims are submitted not after balances age.
Once eligibility handling, billing discipline, and AR ownership are stabilized, outpatient clinics typically see steady, predictable improvements in collections.
Results vary by payer mix, visit complexity, and documentation quality.
We measure success by what gets paid not what gets billed.
Outpatient revenue operations must withstand payer reviews, documentation requests, and routine scrutiny not just submit claims.
Designed to stabilize revenue first then improve it systematically.
01Eligibility gaps, billing errors, AR drivers
02Fix urgent AR aging and denial leakage
03Cleaner claims and fewer rework cycles
04Monthly reporting and clear accountability
Revenue doesn’t stop for vacations, turnover, system changes, or volume spikes. Your RCM partner shouldn’t either.
You don’t need a vendor built for ideal conditions.
You need a partner built for real operations.
The most frequent E/M coding errors we correct include undercoding of office visits (e.g., billing 99213 when documentation supports 99214), incorrect time-based coding without documented total encounter time, missing diagnosis codes that fail to establish medical necessity, and unbundling errors when procedures are performed on the same day. Our coders review each encounter against the 2021 AMA E/M guidelines and payer-specific documentation standards before claim submission.
Yes. CCM (CPT 99490 and 99491) and Annual Wellness Visits (G0438 initial, G0439 subsequent) are among the most underutilized revenue streams in primary care. Many practices have large panels of qualifying patients but never bill for them. We identify all eligible patients, document the required 20+ minutes of monthly CCM care coordination time, and ensure AWV preventive screenings are correctly separated from problem-based E/M visits to avoid bundling denials.
Primary care practices typically see denial rates of 8–12%, driven by medical necessity denials, duplicate submissions, and timely filing lapses. Our first-pass resolution rate for primary care clients exceeds 96%. Every denied claim is worked within 24 hours of the ERA, and we actively track all payer-specific timely filing limits (from 90 days for some commercial plans to 365 days for Medicare) to ensure no claim ages out of appeal eligibility.
Yes. We bill all payer types: Medicare Part B, Medicare Advantage plans, Medicaid fee-for-service and managed care, and all major commercial carriers. Our team stays current on CMS quarterly code updates, Medicare Administrative Contractor (MAC) bulletins, and Local Coverage Determinations (LCDs) that affect primary care billing, ensuring your claims comply with the latest documentation and coverage requirements.
Yes. Transitional Care Management codes (99495 and 99496) are billable when a patient is discharged from a hospital, skilled nursing facility, or community mental health center, and primary care is often the responsible provider. We track discharge notifications, ensure the required 2-day patient contact and 7- or 14-day face-to-face visit conditions are met, and bill accordingly. For Remote Patient Monitoring, we set up billing for CPT 99453, 99454, 99457, and 99458 and coordinate device data documentation with your clinical team.
Our primary care clients see an average 15–22% increase in collected revenue within the first 90 days, driven by three areas: prospective coding review that recovers undercoded visits, systematic billing of previously missed preventive and chronic care codes (CCM, TCM, AWV), and a clean-claims rate above 96% that reduces denial-related write-offs. We provide a monthly performance dashboard showing payment velocity, denial trends by payer, and AR aging analysis so you can track improvement in real time.
Let’s discuss how Aayur Solutions can accelerate your revenue growth and build a more resilient practice.
30 N Gould St Ste R, Sheridan, WY 82801
Remote-first team serving practices across the United States.
A short conversation to understand what’s slowing cash flow.
