Medical billing & revenue cycle management
Medical Billing Built Around the Entire Revenue Cycle
Kitronixe helps medical practices manage the revenue cycle from eligibility and authorization through coding, claims, denials, payment posting, A/R follow-up and reporting - bringing billing operations, workflow visibility and revenue intelligence together.
Claims ready
86
Claims rejected
7
Denials requiring action
23
Outstanding A/R
$142K
Payments posted
$61.4K
Eligibility issues
12
- Authorization pending9
- Unsigned documentation14
- Follow-up required31
Illustrative data for a fictional practice. Not a Kitronixe result, not a client’s data and not a benchmark.
- RCM A–Z
- Coding & claims
- Denials & A/R
- Reporting & revenue intelligence
The connected revenue cycle
Billing is not one task. It is a connected revenue cycle.
Billing is often treated as the step at the end: code the visit, send the claim, wait. In practice, most of what decides whether a claim is paid happens long before it is sent - at registration, at eligibility, at authorization, in the note - and most of what decides whether revenue is collected happens after it comes back.
Kitronixe treats the revenue cycle as one connected workflow rather than a set of separate billing tasks. A problem is traced to where it started, fixed there, and followed through to payment, so the same error does not arrive again next month under a different claim number.
- 01
Eligibility
Coverage not confirmed before the visit becomes a denial weeks later, after the patient has gone.
- 02
Authorization
A service performed without the authorization it needed is often unrecoverable, however good the claim.
- 03
Documentation
A note that does not support the service billed stalls the claim or invites a later recoupment.
- 04
Coding
A code or modifier that does not match the documentation is the start of a denial pattern, not a one-off.
- 05
Claim submission
Claims that sit unbilled let charge lag quietly consume the timely filing window.
- 06
Denial handling
A clearinghouse rejection is usually clerical and fixable same-day - but treated as a denial, it waits in the wrong queue.
- 07
Payment posting
A payment posted without checking it against the expected amount hides the underpayment inside the balance.
- 08
A/R follow-up
A balance nobody owns ages quietly until it reaches a filing limit and stops being collectable.
RCM A–Z
Eleven stages, one team following the claim through all of them
From the appointment to the last patient balance. Engage the whole cycle or a defined part of it - each stage below is available depending on the selected scope.
RCM
Process
01 / 11
Scheduling
What is covered
The full medical billing workload, depending on the scope you choose
Not every engagement includes every capability. The scope is agreed up front, so you know exactly what Kitronixe handles and what stays with your team.
01Before submission
Eligibility verification
Coverage, plan details and benefits confirmed before the visit, where payer systems make them available.
Prior authorization support
Authorization requirements identified and requests coordinated before the service, not discovered after it.
Charge capture review
Encounters checked for missing or late charges before a claim is ever built.
Medical coding
Codes and modifiers assigned to match the documentation, with payer rules applied.
02Claims out the door
Charge entry and claim creation
Accurate, promptly, with edits applied before submission.
Claim scrubbing
Payer and clearinghouse edits run before submission, so predictable errors are caught in-house.
Electronic submission
Primary, secondary and tertiary, with payer-specific requirements handled.
Secondary and tertiary claims
Crossovers and secondary claims followed through rather than left once the primary has paid.
Clearinghouse management
Rejection queues worked daily rather than weekly.
Claim status monitoring
We chase status rather than waiting to be told.
03Payments, denials & A/R
Denial management
Denials worked by root cause, with the pattern reported back so it can be prevented upstream.
Appeals support
Appeals prepared with the documentation the payer actually needs, within the payer’s window.
Payment posting
Payments and adjustments posted accurately, so the balance left is the balance truly owed.
ERA / EOB reconciliation
Remittances reconciled against what was billed and expected, line by line.
A/R follow-up
Outstanding balances worked by priority - payer, age, value and filing risk - rather than by who shouts loudest.
Underpayment identification
Payments below the contracted rate flagged, so they can be pursued through the appropriate recovery service.
Patient balance workflow
Patient statements and balance follow-up handled clearly, after insurance has done its part.
04Visibility & improvement
Reporting and analytics
Regular reporting on claims, payments, denials and A/R, measured the same way every period.
Revenue intelligence
Deeper analysis of leakage, payer behaviour and contract variance, where it is part of the scope.
Workflow optimization
Changes to how work moves between front desk, clinical and billing teams, where the cause sits upstream.
Denials & rejections
Not every unpaid claim is the same problem
A rejection is not a denial, and neither is an underpayment. Each has a different cause, a different owner and a different first step - which is why they are worked separately.
Fixable before the payer decides
After the payer has decided
Fixable before the payer decides
Rejections
- What it is
- Returned before the payer processes the claim - usually a formatting, data or enrollment problem.
- Usually owned by
- Billing
- First action
- Correct the data and resubmit, usually the same day.
Starts and is caught at Submission, before the payer decides.
Eligibility issues
- What it is
- Coverage inactive, plan changed, or the wrong payer billed for the date of service.
- Usually owned by
- Front desk
- First action
- Re-verify coverage, update the payer, and rebill the correct plan.
Starts at Eligibility; surfaces at Payer decision, 5 stages later.
Authorization issues
- What it is
- A service that needed an authorization was performed without one, or outside what was approved.
- Usually owned by
- Patient access
- First action
- Check for a retro-authorization route and fix the scheduling check that missed it.
Starts at Authorization; surfaces at Payer decision, 4 stages later.
Documentation issues
- What it is
- The note does not support the service billed, or a required document is missing.
- Usually owned by
- Clinical
- First action
- Request the missing documentation from the provider before resubmitting.
Starts at Visit note; surfaces at Payer decision, 3 stages later.
Coding issues
- What it is
- A code, modifier or diagnosis pairing the payer does not accept for this service.
- Usually owned by
- Coding
- First action
- Review against the documentation and correct the code or modifier.
Starts at Coding; surfaces at Payer decision, 2 stages later.
Denials
- What it is
- A processed claim the payer has decided not to pay, with a reason code that points at the cause.
- Usually owned by
- Denials team
- First action
- Work to the root cause, then correct, appeal or write off with a reason.
Starts at any earlier stage; surfaces at Payer decision.
Timely filing risk
- What it is
- A claim or appeal approaching the payer’s filing limit, after which it cannot be recovered.
- Usually owned by
- A/R
- First action
- Move it to the front of the worklist and document proof of timely submission.
Starts at Submission; surfaces at Posting & follow-up, 2 stages later.
Payer follow-up
- What it is
- A claim with no response, or a status that has not moved within the expected window.
- Usually owned by
- A/R
- First action
- Contact the payer through its portal or line and record the outcome.
Starts at Payer decision; surfaces at Posting & follow-up, 1 stage later.
Underpayments
- What it is
- A claim paid, but below the contracted rate for the codes billed.
- Usually owned by
- Revenue integrity
- First action
- Flag the variance and route it to the appropriate recovery process.
Starts at Payer decision; surfaces at Posting & follow-up, 1 stage later.
A category, not a finding: how each is worked in your practice depends on your payers, your systems and the scope agreed.
Fixable before the payer decides
Rejections
- What it is
- Returned before the payer processes the claim - usually a formatting, data or enrollment problem.
- Usually owned by
- Billing
- First action
- Correct the data and resubmit, usually the same day.
Starts and is caught at Submission, before the payer decides.
Eligibility issues
- What it is
- Coverage inactive, plan changed, or the wrong payer billed for the date of service.
- Usually owned by
- Front desk
- First action
- Re-verify coverage, update the payer, and rebill the correct plan.
Starts at Eligibility; surfaces at Payer decision, 5 stages later.
Authorization issues
- What it is
- A service that needed an authorization was performed without one, or outside what was approved.
- Usually owned by
- Patient access
- First action
- Check for a retro-authorization route and fix the scheduling check that missed it.
Starts at Authorization; surfaces at Payer decision, 4 stages later.
Documentation issues
- What it is
- The note does not support the service billed, or a required document is missing.
- Usually owned by
- Clinical
- First action
- Request the missing documentation from the provider before resubmitting.
Starts at Visit note; surfaces at Payer decision, 3 stages later.
Coding issues
- What it is
- A code, modifier or diagnosis pairing the payer does not accept for this service.
- Usually owned by
- Coding
- First action
- Review against the documentation and correct the code or modifier.
Starts at Coding; surfaces at Payer decision, 2 stages later.
After the payer has decided
Denials
- What it is
- A processed claim the payer has decided not to pay, with a reason code that points at the cause.
- Usually owned by
- Denials team
- First action
- Work to the root cause, then correct, appeal or write off with a reason.
Starts at any earlier stage; surfaces at Payer decision.
Timely filing risk
- What it is
- A claim or appeal approaching the payer’s filing limit, after which it cannot be recovered.
- Usually owned by
- A/R
- First action
- Move it to the front of the worklist and document proof of timely submission.
Starts at Submission; surfaces at Posting & follow-up, 2 stages later.
Payer follow-up
- What it is
- A claim with no response, or a status that has not moved within the expected window.
- Usually owned by
- A/R
- First action
- Contact the payer through its portal or line and record the outcome.
Starts at Payer decision; surfaces at Posting & follow-up, 1 stage later.
Underpayments
- What it is
- A claim paid, but below the contracted rate for the codes billed.
- Usually owned by
- Revenue integrity
- First action
- Flag the variance and route it to the appropriate recovery process.
Starts at Payer decision; surfaces at Posting & follow-up, 1 stage later.
Accounts receivable
A/R needs action—not just an aging report
An aging report shows where money is. It does not say what to do about it first. Kitronixe can help organize outstanding balances into a worklist, so the balance with the least time left or the most at stake is worked before the one that is merely oldest.
- Payer
- Age
- Balance
- Denial status
- Claim status
- Follow-up needed
- Timely-filing risk
- Documentation issue
No recovery amount or collection rate is promised: what a worklist recovers depends on the balances, the payers and how long they have already been left.
A/R worklist
Organize the same balances a different way
Worklist organized by timely-filing risk.
| Payer | Age | Balance | Status | Next action | Filing limit |
|---|---|---|---|---|---|
| Payer CNext up | 104 days | $1,840 | Denied · Authorization | Appeal due | 12 days left |
| Payer A | 91 days | $2,410 | Pending | Status check | 18 days left |
| Payer B | 76 days | $920 | Denied · Documentation | Request records | 29 days |
| Payer B | 62 days | $1,275 | Denied · Coding | Correct & resubmit | 41 days |
| Payer A | 47 days | $3,260 | No response | Call payer | 58 days |
| Payer D | 33 days | $610 | Paid short | Review variance | 87 days |
Payer CNext up
$1,840
- Age
- 104 days
- Status
- Denied · Authorization
- Next action
- Appeal due
- Filing limit
- 12 days left
Payer A
$2,410
- Age
- 91 days
- Status
- Pending
- Next action
- Status check
- Filing limit
- 18 days left
Payer B
$920
- Age
- 76 days
- Status
- Denied · Documentation
- Next action
- Request records
- Filing limit
- 29 days
- Documentation
- Issue to resolve
Payer B
$1,275
- Age
- 62 days
- Status
- Denied · Coding
- Next action
- Correct & resubmit
- Filing limit
- 41 days
- Documentation
- Issue to resolve
Payer A
$3,260
- Age
- 47 days
- Status
- No response
- Next action
- Call payer
- Filing limit
- 58 days
Payer D
$610
- Age
- 33 days
- Status
- Paid short
- Next action
- Review variance
- Filing limit
- 87 days
Illustrative data only: invented balances for a fictional practice, with payers shown as letters. It shows how a worklist can be organized - not a Kitronixe result or a recovery figure.
Reporting & visibility
See what the billing is doing, without having to ask
Regular reporting on the measures that matter to billing, defined the same way every period so that a change is a change and not a new definition.
- Claims submitted
- Payments
- Denials
- Rejections
- A/R aging
- Payer performance
- Provider performance
- Patient balances
- Underpayments
- Outstanding work
- Billing productivity
- Revenue trends
Technology & workflow
Your billing workflow is only as strong as the systems behind it
Effective billing depends on people and process - and on how the practice’s systems are configured and actually used. A rule that is never switched on, a work queue nobody owns, a report that does not answer the question: each shows up later as billing work.
Where it is separately engaged, Kitronixe can also help with workflow, reporting and system optimization.
- Rules and edits that catch errors before submission
- Work queues with clear ownership
- Reports built around the questions you ask
- Workflows that match how each team works
- Explore Kitronixe Consulting
Why Kitronixe
What working with Kitronixe on billing is like
End-to-end revenue cycle perspective
Billing decisions made with the whole cycle in view, from scheduling to the last patient balance.
Billing and workflow expertise
People who understand both how a claim is built and how the work behind it moves.
Operational visibility
You can see what is outstanding, what is stuck and what is being worked, without having to ask.
Data-driven follow-up
Work prioritized by value, age and risk, so effort goes where it recovers the most.
Practice-specific workflows
Processes shaped around how your practice runs, rather than a template applied to everyone.
Reporting and revenue intelligence
Reporting that explains the numbers, with deeper analysis available when you need it.
Technology-aware RCM
Billing recommendations made with an understanding of how your systems are configured and used.
Dedicated partnership
A consistent team that learns your practice, rather than a queue that starts over each time.
Illustrative workflow example
Fixing the cause, not just the claim
One denial, followed to its cause
Sample RCM scenario- 01 · Denied
A claim comes back denied for a missing authorization.
- 02 · Traced
The cause is upstream: the scheduling check did not flag this service as needing one.
- 03 · Fixed at the source
A retro-authorization route is checked, and the scheduling check is updated for this service.
- 04 · Followed through
The claim is resubmitted where possible, and the next one is caught before the visit.
A sample scenario to show how Kitronixe works a problem back to where it started. It is not an actual client result and describes no real practice.
Common questions
Medical billing, answered plainly
Do you work inside our existing systems?
Yes. Kitronixe works in your EHR and practice management system rather than requiring a migration. Your data stays where it is.
How long does a transition take?
It depends on volume and how many payers are involved. We transition in stages rather than all at once, so nothing stops while the changeover happens.
What do you report on?
Days in A/R, denial rate, clean claim rate and net collection rate, monthly and against an agreed baseline. If performance slips you will see it in a report before you hear it in a meeting.
What does your medical billing service include?
It depends on the scope you choose. An engagement can cover the full revenue cycle - eligibility, authorization, coding, claims, denials, posting, A/R and reporting - or a defined part of it. The scope is agreed up front, so you know exactly what is and is not included.
What is the difference between a rejection and a denial?
A rejection is returned before the payer processes the claim - usually by the clearinghouse, for a formatting, data or eligibility problem - and can often be corrected and resubmitted the same day. A denial is a processed claim the payer has decided not to pay, which needs investigation and often an appeal. Treating one like the other puts work in the wrong queue.
Do you work denials and appeals?
Yes, where they are part of the scope. Denials are worked by root cause, appeals are prepared with the documentation the payer needs, and patterns are reported back so the cause can be fixed upstream rather than appealed again next month.
How do you prioritize A/R follow-up?
By what a balance is worth and how much time it has left: payer, age, balance, claim and denial status, documentation issues and timely-filing risk. An aging report shows where money is; a prioritized worklist decides what to do about it first.
Do you handle patient balances and statements?
Patient balance workflow can be part of the scope, handled after insurance has done its part so the amount a patient is asked for is the amount they actually owe.
How is medical billing priced?
Pricing depends on scope, volume and specialty, so it is quoted rather than published. An RCM assessment is the usual starting point, and you can also request pricing directly.
Start with where your revenue cycle actually stands.
An RCM assessment looks at your own claims, denials and A/R before anything is recommended, and you keep the findings either way.