Understand, improve, and manage your revenue cycle
US Medical Billing helps healthcare organizations with expert revenue-cycle services, reliable knowledge, and practical software tools.
- Intake: encounter created.
- Eligibility (270/271): coverage verified.
- Coding (CPT·ICD-10): charges coded.
- Submission (837): clean claim out.
- Adjudication: under review.
- Payment (835): paid · posted.
- Denial (CARC/RARC): worked · appealed.
- Reporting: reconciled.
- At Adjudication the claim is paid or denied; a worked denial is resubmitted, and Reporting closes the loop back to Intake.
Transparent process
We explain the process and what it means for your revenue — no jargon, no surprises.
Reliable knowledge
A practical knowledge base of the revenue cycle — claims, denials, payments, and credentialing.
Clear reporting
Reporting that shows what happened and where revenue can improve.
Full-service revenue cycle management
Services across the revenue cycle, organized into three pathways. Explore what we do.
Core billing operations
Getting a clean claim out and the money in.
Prevent & recover denials
Stopping denials upstream and winning them back.
Provider & patient
Enrollment on one side, clear statements on the other.
Follow a claim through the revenue cycle
One sample claim, end to end — select any stage, or let it run.
claim CLM-2026-0000 · $240.00 · illustrative — sample data
Encounter created
Intake
The revenue cycle begins before care is billed — capturing accurate patient demographics, the responsible insurance, and the reason for the visit. A transposed member ID or a stale plan entered here surfaces much later as a rejection or denial, which is why intake is the cheapest place to prevent them.
> encounter registered · demographics + coverage captured created
- Intake: Encounter created. The revenue cycle begins before care is billed — capturing accurate patient demographics, the responsible insurance, and the reason for the visit. A transposed member ID or a stale plan entered here surfaces much later as a rejection or denial, which is why intake is the cheapest place to prevent them.
- Eligibility: Coverage confirmed. Before or at the visit the payer is checked electronically — an X12 270 request and 271 response — to confirm the patient is covered, that the service is a benefit, and what the patient will owe. Verifying eligibility up front removes a large share of avoidable denials.
- Coding: Charges coded. The documented encounter is translated into standardized codes — CPT and HCPCS for what was done, ICD-10-CM for why — each supported by the clinical documentation. Accurate, compliant coding is the foundation of a correct claim; it is not where charges are inflated.
- Submission: Claim submitted. Coded charges become a claim — an X12 837 — and are transmitted to the payer, usually through a clearinghouse that scrubs it against edits first. A claim that passes these front-door edits and is accepted on the first submission is a clean claim.
- Adjudication: Under review. The payer applies the member's benefits and its medical-necessity and coding rules to decide what it will pay. This is the decision point of the cycle: a claim leaves adjudication on one of two paths — paid, in full or in part, or denied.
- Payment: Paid. The payer returns an electronic remittance — an X12 835 — with the allowed amount, the paid amount, contractual adjustments, and any patient responsibility. Posting it accurately reconciles the claim, moves any balance to the patient, and reveals underpayments that would otherwise be lost.
- Denial: Action required. A denial carries reason and remark codes (CARC/RARC) that explain why. Denials are worked, not written off: the cause is diagnosed, corrected, and the claim is appealed or corrected and resubmitted — which routes it back through submission. The share overturned on appeal is a measure of how recoverable that revenue was.
- Reporting: Measured. Every outcome — clean-claim rate, denial rate, days in A/R, collection rates — feeds reporting that shows where revenue leaks and where the process is working. Those measures close the loop back to intake, where the next cycle's problems are cheapest to prevent.
- At Adjudication the claim branches to Payment or Denial; an appealed denial routes back through Submission.
Billing by specialty
Coding, payer rules, and documentation differ from one specialty to the next. These guides explain how each one's revenue cycle works.
Practical calculators for the revenue cycle
Real, working calculators — every figure is yours, the result is your own arithmetic, and nothing is stored or sent.
denial-rate-calculator
Denial rate calculator
Enter your own figures — it calculates live, in your browser, and stores nothing.
Claims the payer refused to pay after adjudication. A rejection that never reached adjudication is not a denial.
Your chosen denominator, over the same period. Conventions vary — see the assumptions below.
Enter your figures to see the result and a breakdown.
A knowledge base built like documentation
Clear, practical explanations of the revenue cycle — pick a category to browse its articles right here, then open any one to read it in full.
Categories
Revenue Cycle Management
Understand the healthcare revenue cycle — what it is, how its stages fit together, and the articles, services, and tools that teach and support each part.
- What Is Revenue Cycle Management (RCM)?
- The Stages of the Revenue Cycle, in Depth
- Revenue Cycle KPIs: Reading the Metrics Together
- In-House vs. Outsourced RCM: A Decision Framework
- Revenue Cycle Governance: Ownership and Decision Rights
- Building a Revenue Cycle Operating Model
- Mapping Work from Patient Access to Final Balance
- Revenue Cycle Handoffs and Control Points
- Designing a Revenue Cycle Policy Library
- Building a Revenue Cycle Issue Escalation Path
- Revenue Cycle Data Definitions and Metric Governance
- Creating a Revenue Cycle Meeting Cadence
- Documenting Revenue Cycle Standard Operating Procedures
- Revenue Cycle Change Management
- Separating Work Queues from Reporting Views
- Revenue Cycle Roles and Accountability
- Building a Revenue Cycle Risk Register
- Revenue Cycle Process Mapping
- Managing Revenue Cycle Exceptions
- Establishing Revenue Cycle Service Levels
- Revenue Cycle Root-Cause Analysis
- Revenue Cycle Quality Assurance
- Revenue Cycle Business Continuity Planning
- Evaluating Revenue Cycle Technology Changes
Understand the healthcare revenue cycle — what it is, how its stages fit together, and the articles, services, and tools that teach and support each part.
- What Is Revenue Cycle Management (RCM)?
- The Stages of the Revenue Cycle, in Depth
- Revenue Cycle KPIs: Reading the Metrics Together
- In-House vs. Outsourced RCM: A Decision Framework
- Revenue Cycle Governance: Ownership and Decision Rights
- Building a Revenue Cycle Operating Model
- Mapping Work from Patient Access to Final Balance
- Revenue Cycle Handoffs and Control Points
- Designing a Revenue Cycle Policy Library
- Building a Revenue Cycle Issue Escalation Path
- Revenue Cycle Data Definitions and Metric Governance
- Creating a Revenue Cycle Meeting Cadence
- Documenting Revenue Cycle Standard Operating Procedures
- Revenue Cycle Change Management
- Separating Work Queues from Reporting Views
- Revenue Cycle Roles and Accountability
- Building a Revenue Cycle Risk Register
- Revenue Cycle Process Mapping
- Managing Revenue Cycle Exceptions
- Establishing Revenue Cycle Service Levels
- Revenue Cycle Root-Cause Analysis
- Revenue Cycle Quality Assurance
- Revenue Cycle Business Continuity Planning
- Evaluating Revenue Cycle Technology Changes
Ready to improve your revenue cycle?
Tell us about your practice and we’ll tell you where we would start.