REVENUE CYCLE MANAGEMENT

Revenue Cycle Management Services for Healthcare Practices

From scheduling to reporting, explore the 14 steps that connect patient care with practice revenue.

Medical billing support across the revenue cycle

Clarinza RCM connects patient registration, insurance eligibility, coding, claims and payment follow-up. We help your team organize missing information, track payer responses and identify the next action on outstanding balances.

Explore the steps below to see how front-office preparation, accurate documentation and consistent denial follow-up work together. Reporting brings open tasks and recurring issues into view so your practice can set clear priorities.

01
Step 1 of 14
Pre-Registration / Patient Scheduling
Start the encounter with a usable patient record.
- Capture demographic, insurance, and contact details at the time of scheduling.
- Verify the appointment type and provider to anticipate documentation needs.
- Flag high-risk accounts (self-pay, out-of-network) early.
How this connects
The records and open questions from this stage support the next step: Insurance Verification & Eligibility Check. Keep responsibilities and outstanding actions visible as work moves forward.
02
Step 2 of 14
Insurance Verification & Eligibility Check
Identify coverage questions before services are provided.
- Confirm active coverage, plan type, and effective dates with the payer.
- Check co-pay, co-insurance, deductible status, and plan limitations.
- Identify whether the service requires a referral or prior authorization.
How this connects
The records and open questions from this stage support the next step: Prior Authorization & Referral Management. Keep responsibilities and outstanding actions visible as work moves forward.
03
Step 3 of 14
Prior Authorization & Referral Management
Connect planned services with required payer documentation.
- Submit and track authorization requests for procedures that require payer approval.
- Obtain and log referrals from primary care or referring providers.
- Prevent avoidable denials by securing approval before the date of service.
How this connects
The records and open questions from this stage support the next step: Patient Check-In & Financial Counseling. Keep responsibilities and outstanding actions visible as work moves forward.
04
Step 4 of 14
Patient Check-In & Financial Counseling
Help patients understand the financial part of their visit.
- Collect co-pays and outstanding balances at the point of service.
- Review and update insurance and demographic information.
- Provide cost estimates and discuss payment plans where applicable.
How this connects
The records and open questions from this stage support the next step: Charge Capture. Keep responsibilities and outstanding actions visible as work moves forward.
05
Step 5 of 14
Charge Capture
Make documented services available to the billing team.
- Record every billable service, procedure, and supply rendered during the visit.
- Reconcile charges against the clinical documentation and encounter form.
- Route missing or incomplete charge tickets back to the clinical team.
How this connects
The records and open questions from this stage support the next step: Medical Coding (ICD-10-CM, CPT, HCPCS). Keep responsibilities and outstanding actions visible as work moves forward.
06
Step 6 of 14
Medical Coding (ICD-10-CM, CPT, HCPCS)
Align the claim with the clinical record.
- Translate clinical documentation into accurate diagnosis and procedure codes.
- Apply correct modifiers and ensure medical necessity is supported.
- Perform coding audits to reduce compliance risk and denials.
How this connects
The records and open questions from this stage support the next step: Charge Entry & Claim Creation. Keep responsibilities and outstanding actions visible as work moves forward.
07
Step 7 of 14
Charge Entry & Claim Creation
Create a complete claim ready for review.
- Enter coded charges into the practice management / billing system.
- Apply fee schedules and payer-specific billing rules.
- Build the claim in the correct format (CMS-1500 or UB-04).
How this connects
The records and open questions from this stage support the next step: Claim Scrubbing & Compliance Check. Keep responsibilities and outstanding actions visible as work moves forward.
08
Step 8 of 14
Claim Scrubbing & Compliance Check
Identify correctable issues before the claim leaves the practice.
- Run claims through edits for missing data, mismatched codes, and payer rules.
- Check NCCI edits, LCD/NCD policies, and timely filing limits.
- Correct errors before submission to reduce first-pass rejections.
How this connects
The records and open questions from this stage support the next step: Claim Submission. Keep responsibilities and outstanding actions visible as work moves forward.
09
Step 9 of 14
Claim Submission
Confirm that a claim reached the next processing stage.
- Submit clean claims electronically (EDI 837) to payers or clearinghouses.
- Submit secondary and tertiary claims once primary payer adjudicates.
- Track submission confirmations and clearinghouse rejection reports.
How this connects
The records and open questions from this stage support the next step: Payment Posting & Remittance Processing. Keep responsibilities and outstanding actions visible as work moves forward.
10
Step 10 of 14
Payment Posting & Remittance Processing
Build an accurate record of payment and remaining balances.
- Post payments from ERA/EOB (electronic remittance advice) files.
- Reconcile contracted vs. allowed amounts and identify underpayments.
- Post patient payments, adjustments, and write-offs accurately.
How this connects
The records and open questions from this stage support the next step: Denial Management & Appeals. Keep responsibilities and outstanding actions visible as work moves forward.
11
Step 11 of 14
Denial Management & Appeals
Give each denial a documented reason and next action.
- Categorize denials by reason code (eligibility, authorization, coding, medical necessity).
- File timely, well-documented appeals with supporting clinical evidence.
- Track denial trends to prevent recurring revenue leakage.
How this connects
The records and open questions from this stage support the next step: Accounts Receivable (A/R) Follow-Up. Keep responsibilities and outstanding actions visible as work moves forward.
12
Step 12 of 14
Accounts Receivable (A/R) Follow-Up
Keep unresolved balances moving through a follow-up worklist.
- Work aging claim buckets (30/60/90/120+ days) with payers proactively.
- Escalate unresolved claims and monitor payer turnaround compliance.
- Reduce days in A/R and improve overall collection velocity.
How this connects
The records and open questions from this stage support the next step: Patient Billing & Statements. Keep responsibilities and outstanding actions visible as work moves forward.
13
Step 13 of 14
Patient Billing & Statements
Explain remaining patient responsibility after payer processing.
- Generate clear, itemized patient statements after insurance adjudication.
- Offer online payment portals, payment plans, and reminder communications.
- Route qualifying balances to collections per practice policy.
How this connects
The records and open questions from this stage support the next step: Reporting, Analytics & Continuous Improvement. Keep responsibilities and outstanding actions visible as work moves forward.
14
Step 14 of 14
Reporting, Analytics & Continuous Improvement
Use recurring issues to improve the next revenue cycle.
- Track KPIs: net collection rate, clean claim rate, denial rate, days in A/R.
- Deliver monthly performance dashboards and financial reporting to clients.
- Use data trends to refine front-end processes and reduce future denials.
How this connects
Findings from this stage inform the next cycle. Review recurring issues with the practice and update the relevant worklists and preparation steps.

Where revenue cycle work can stall

Before a claim is created

Incomplete demographics, coverage questions and missing documentation can interrupt the handoff from front office to billing. Assign missing-information requests before they become a backlog.

After submission

A clearinghouse rejection and a payer denial need different responses. Record the status, responsible person and next action so claims do not disappear between worklists.

When balances remain open

Reconcile remittances before deciding whether a balance belongs with the payer, the patient or an adjustment review. Aging reports help prioritize follow-up; they do not explain every delay on their own.

SERVICES THAT CONNECT