Everything you need to know about partnering with Rcmaxis — from onboarding to collections, compliance to credentialing.
Rcmaxis specializes in revenue cycle management for specialty physician practices and behavioral health centers across the US. Our core specialties include:
We also work with multi-specialty groups, hospital-employed physician groups, and telehealth practices.
Most billing companies are generalists. Rcmaxis is built around specialty-specific expertise. The difference shows up in three areas:
We also don't lock you into multi-year contracts. We earn your business every month through measurable results.
The process is straightforward and low-risk:
There's no obligation after the free audit, and no long-term contract required to start.
Request your free audit →Most practices are fully onboarded and submitting claims within 10–14 business days. The process involves:
Practices with complex credentialing needs or payer enrollment changes may take 3–4 weeks. Your clinical staff continues working as normal throughout.
Most practices see measurable AR improvement within 60 days of go-liveYes — many of our clients come to us directly from in-house billing for the first time. We handle the full transition, including:
The transition is designed to be invisible to your patients and low-friction for your physicians. We've onboarded dozens of practices making their first outsourcing move and have a tested playbook for it.
Yes. We offer a free revenue cycle audit — a no-obligation assessment that includes:
The audit takes 5 business days and costs nothing. We share the full findings regardless of whether you engage us.
Request your free audit →Yes. Some practices use Rcmaxis for specific functions — such as denial management, aged AR recovery, or credentialing — while retaining their in-house team for front-end billing. We can operate as a full outsourced billing department or as a specialized supplement to your existing staff. We define scope clearly upfront so there are no overlaps or coverage gaps.
We maintain a 98.4% first-pass clean claim rate — significantly above the industry average of 80–85%. This is achieved through:
A higher clean claim rate means fewer rejections, faster adjudication, and more days taken out of your AR cycle.
Industry avg: 80–85% · Rcmaxis: 98.4%Claims are reviewed, scrubbed, and submitted electronically within 24 hours of the date of service. For surgical cases requiring implant documentation or operative reports, we submit as soon as the clinical documentation is complete — typically within 48 hours. We submit to all commercial, Medicare, and Medicaid payers, including secondary and tertiary billing.
These are two different problems with different solutions:
Our pre-submission scrubbing eliminates the majority of rejection causes before a claim ever leaves our system. Denials are worked within 48 hours of receipt.
Yes, we handle full coordination of benefits (COB) billing. After primary insurance adjudicates, we automatically generate and submit claims to secondary payers with the primary EOB attached — electronically where supported, paper where required. For Medicare/Medicaid dual-eligible patients, we follow MSP (Medicare Secondary Payer) rules and cross-over claim procedures. Tertiary billing (rare but applicable in some commercial + Medicare supplement scenarios) is also handled.
Yes. Prior authorization management is included in all service tiers. We handle:
Our 94%+ auth approval rate reduces treatment delays and eliminates auth-related denials before claims are ever submitted.
After insurance adjudication, we generate accurate patient statements and manage the patient balance workflow. This includes clear itemized statements, follow-up communication on outstanding balances, payment plan setup and management, and coordination with patient financing options if needed. We prioritize professional, HIPAA-compliant patient communication — our approach protects your patient relationships while improving collections.
Yes. We bill for Medicare Part B, Medicare Advantage, Medicaid, and dual-eligible patients in all US states. Our team is current on Medicare Fee Schedule updates, LCD and NCD coverage determinations by MAC jurisdiction, state-specific Medicaid billing rules and portals, managed Medicaid and behavioral health carve-out plans, and Medicare Secondary Payer (MSP) coordination rules.
We use percentage-of-collections pricing — you pay only when we collect revenue for your practice. Our rates:
There are no setup fees, no monthly minimums, no per-claim fees, and no software costs. Your fee is calculated on net collections — money your practice actually receives — not charges submitted.
View full pricing details →No long-term contracts and no cancellation fees. We operate on a month-to-month basis with a standard 30-day notice period. We earn your business by delivering results every month — not by locking you into a multi-year agreement. Most clients stay because their collections improve. If performance ever falls short of expectations, you can exit without penalty.
Our percentage fee covers the full scope of billing and RCM services. The only costs outside our fee are your existing EHR/PM system subscription, postage for paper statements if your practice requires mailed patient statements, and optional credit card processing fees if patients pay via patient portal. We don't charge extra for credentialing updates, coding audits, denial appeals, AR recovery, or monthly reporting — these are included in every engagement.
No additional fees. When you come onboard, our team reviews and works your existing AR and unpaid claims as part of the standard engagement. Any collections recovered from that backlog are billed at your standard percentage rate — the same as new claims. We don't charge a higher "recovery fee" for older or more complex claims. This is why many practices recover significant amounts in their first 90 days with us.
Your data is yours. Upon termination, we provide a complete export of all billing records, AR history, payment posting data, and claim history in a standard format compatible with your EHR/PM system. We work through open claims during the transition window and transfer all payer portal access back to you. Our standard offboarding takes 30 days to ensure nothing falls through the cracks.
In-house billing typically costs 12–18% of collections once you factor in salary, benefits, PTO, training, clearinghouse fees, and software. Rcmaxis costs 2–7% of collections — and we bring a full team of specialists rather than a generalist biller who may leave.
Absolutely. Aged AR recovery is one of our core strengths. When onboarding, our team performs a retrospective review of your AR going back 90–180 days to identify denials never appealed, claims submitted but never adjudicated, underpayments from payer contractual errors, and incorrectly written-off balances. Many new clients recover $20K–$150K+ in their first 90 days simply from working existing aged AR their previous biller had ignored.
80%+ recovery rate on properly worked aged claimsOur managed denial rate is under 2.1% — vs. the industry average of 8–12%. Prevention is the primary strategy: pre-submission eligibility verification, specialty-specific coding review, payer-specific rule monitoring, authorization gap tracking, and documentation flags sent back to clinical staff before submission. When denials do occur, we work them within 48 hours. Our appeal success rate on clinical denials exceeds 70% at first level.
Timely filing is each payer's deadline for submitting claims after the date of service. Missing this deadline results in a permanent denial with no appeal path — the revenue is simply gone. Common limits: Medicare 12 months, most commercial payers 90–180 days, some as short as 30–45 days. We track timely filing limits for every payer in your mix and flag any claim approaching its deadline before it expires. Our 24-hour submission standard eliminates virtually all timely filing risk on new claims.
Underpayments — where a payer pays less than your contracted rate — are a significant and often overlooked revenue leak. Our process:
Most practices find underpayments represent 3–8% of total collections when they first audit their remittances carefully.
Appeals success varies by denial type:
If your practice receives a RAC, MAC, ZPIC, or commercial payer audit, our team provides complete audit response support: documentation compilation and review, written response letters and appeal preparation, overpayment dispute filings, and recoupment hold negotiation when applicable. We also perform proactive internal coding audits quarterly so that if a payer audit occurs, your documentation is already well-organized and defensible.
We integrate with 40+ EHR and practice management systems, including:
We don't require you to switch systems. Our team works within your existing platform.
View full EHR integration list →No. We work within your existing EHR and PM system. Changing systems is disruptive and expensive — we have no reason to push you toward new software. Our billers are trained in your current platform and operate directly inside it, just as your own staff would. If your EHR isn't on our standard integration list, we assess compatibility during the free audit phase.
Provider completes the encounter in your EHR. Our billing team reviews the charge for accuracy — missing modifiers, diagnosis linking, bundling rules. Any documentation gaps are flagged back to the provider with specific guidance. Once clean, the claim is submitted within 24 hours. We also perform periodic charge lag audits to identify procedures performed but never captured — a common revenue leak in surgical and procedural practices.
We handle all payment posting. When an Electronic Remittance Advice (ERA) arrives, our team posts each payment to the correct claim in your PM system, applies contractual adjustments, and identifies patient responsibility balances for statement generation. Paper EOBs from payers that don't support ERA are manually posted. Each payment is verified against your contracted rates — variances flag automatically for underpayment review. Your bank deposits and PM system totals are reconciled daily.
Yes. Patient statements include a payment link where patients can pay balances online by credit card or ACH bank transfer. Payments are posted automatically to the correct patient account in your PM system. For patients who prefer to pay over the phone, we provide a secure IVR payment option as well. All patient payment processing is PCI-DSS compliant. You can also configure payment plans through our system — installment amounts and schedules are managed automatically.
Yes. Rcmaxis is fully HIPAA compliant and SOC 2 Type II certified. Our security program includes all PHI encrypted at rest (AES-256) and in transit (TLS 1.2+), role-based access controls, annual HIPAA risk assessments and staff training, Business Associate Agreements (BAAs) executed with every client, and a 24-hour breach notification procedure. We provide our SOC 2 report and BAA on request before engagement begins.
SOC 2 Type II certified · HIPAA compliant · BAA providedA Business Associate Agreement is a HIPAA-required contract between a healthcare provider (you) and any vendor that handles Protected Health Information (PHI) on your behalf — including billing companies. The BAA specifies how PHI will be used, protected, and returned or destroyed at the end of the engagement. Without a signed BAA, you're in violation of HIPAA and exposed to OCR penalties. We execute a BAA with every client before accessing any patient data — it's one of the first documents in our onboarding package.
We maintain a formal incident response plan. In the event of a confirmed breach or suspected unauthorized access to PHI, our obligations include: notifying you within 24 hours of discovery, conducting a full forensic investigation, notifying affected individuals as required by HIPAA (within 60 days), filing reports with HHS/OCR as required, and cooperating with any investigation. Our cyber liability insurance covers breach response costs. We conduct annual penetration testing and quarterly security reviews to minimize breach risk proactively.
Yes. Our coding team holds active AAPC credentials including CPC (Certified Professional Coder), CCS (Certified Coding Specialist), and specialty-specific certifications such as COC, CRC, and CPC-P designations. All coders complete annual continuing education to maintain certification and stay current on CPT, ICD-10, and HCPCS updates. We assign coders based on specialty — a mental health practice gets a coder with behavioral health credentials, not a generalist.
Our compliance and education team monitors annual CPT and ICD-10 code updates, CMS final rules for Medicare physician fee schedule changes, LCD/NCD updates from each Medicare Administrative Contractor, individual payer bulletins and policy change notices, and OIG Work Plan updates and RAC audit focus areas. When a change affects your specialty or payer mix, your account manager briefs your team with specific guidance — you don't need to track it yourself.
Every client receives a dedicated KPI dashboard updated daily with collections, AR performance (days in AR, aging buckets), claim quality metrics, payer breakdowns, and per-provider performance for group practices. Your account manager delivers a written monthly performance report with trend analysis, denial root cause breakdown, and action items. Quarterly business reviews are included for mid-size and enterprise clients.
Yes. Your monthly report includes your KPIs alongside specialty benchmarks so you can see exactly how your practice compares to similar practices nationally. Benchmarks include clean claim rate by specialty, days in AR by specialty, denial rate by payer type, and collection ratio by specialty and payer mix. These benchmarks are drawn from MGMA, AMA, and our own aggregate client data. This context helps you understand whether a metric is a practice-specific issue or an industry-wide challenge.
Your account manager reaches out proactively on a weekly basis during the first 60 days after go-live, then transitions to monthly formal check-ins with ad hoc communication as needed. You'll always hear from us when: a denial pattern changes significantly, a payer policy update affects your specialty, an unusually large claim is adjudicated, or an AR metric trends in the wrong direction. We don't wait for you to ask — you'll hear about issues before they become problems.
Every client is assigned a named account manager — your single point of contact who knows your practice, your payer mix, and your billing history. Your account manager is reachable by email and phone during business hours, delivers your monthly performance review, and proactively communicates about claim issues, payer changes, or AR trends. You'll never deal with a rotating support queue.
Our billing operations team works Monday through Friday, 9 AM – 6 PM EST. Routine inquiries are responded to within 4 business hours. Urgent billing issues (payer portal errors, authorization expirations, claim batch failures) are escalated and addressed same day. Your account manager's direct contact is provided at onboarding.
Cash flow continuity during transition is a top priority. Our approach:
Most practices see no gap in collections during transition and often experience a collections increase within the first 30 days as we catch billing issues from the prior system.
Yes. We offer a free 30-minute strategy call where we walk through our reporting dashboards, billing workflow, and communication process using examples from your specialty. We can show sample monthly reports and denial analysis from anonymized client accounts.
Schedule a call →Yes. Credentialing support is available as part of full-service engagements and as a standalone service. We handle initial provider credentialing with Medicare, Medicaid, and all major commercial payers; CAQH ProView setup and ongoing attestation management; re-credentialing and re-validation before deadlines; and hospital privilege applications when needed. We recommend starting the credentialing process at least 90–120 days before a new provider's first patient date to avoid revenue gaps.
Medicare enrollment (PECOS): 30–60 days. Medicaid: 45–90 days (state-dependent). Commercial payers: 60–120 days each. The main factors that slow credentialing down are incomplete or expired CAQH profiles, gaps in work history documentation, malpractice coverage below payer minimums, and delays in primary source verification (medical school, residency, board certs). We track every application and follow up proactively with payers so you don't have to.
Start credentialing 120 days before the provider's first patient dateYes, with limitations. Two legitimate options exist during the credentialing gap:
Billing under a credentialed colleague's NPI without meeting these requirements is a HIPAA and False Claims Act violation. We advise clients on the safest path during the gap period.
A credentialing lapse — missing a re-credentialing or re-validation deadline — results in the provider being terminated from the payer network. Claims submitted after termination are denied, and retroactive recovery is often impossible. For Medicare specifically, CMS deactivates billing privileges and claims submitted after deactivation are not recoverable. We maintain a re-credentialing calendar for all providers in our client accounts and send alerts 90 and 30 days before each deadline — lapse prevention is included in our service.
Our team responds within one business day. Or skip straight to a free revenue audit — we'll show you exactly what we'd fix in your practice, at no cost and no obligation.