Maximize Revenue with Advanced Medical Billing Solutions

Answer

Outsourcing replaces single-point-of-failure staffing with a full RCM team while cutting overhead by up to 25%. You eliminate the 30% annual biller turnover rate, hit a 95%+ first-pass clean claim rate, and lift net collections by up to 30%.

Industry Insight

Overwhelmed in-house billers quietly write off complex secondary claims or low-dollar CO-16 denials just to clear their queue. Outsourcing separates duties: the person posting payments isn't the person approving write-offs.

Citation

MGMA: In-house RCM staffing consumes approximately 14% of total practice revenue; CAQH: Managed RCM saves $11–$16 per claim transaction.

Answer

We don’t have to replace them—we co-source. We absorb high-friction bottlenecks like 60–120+ day AR, prior authorizations, eligibility, or credentialing so your staff can focus on front-desk care and daily charge entry.

Industry Insight

An internal biller wearing five hats will always prioritize today's charges over sitting on hold with Blue Cross or Medicaid for 45 minutes to fight a 90-day appeal.

Follow-Up

“How many hours a week is your team stuck on hold fighting old AR versus getting today's claims out?”

Citation

MGMA Stat Poll: 73% of practices face RCM staffing shortages, with AR follow-up and denials ranked as the number one neglected task.

Answer

Most of our partners did when we met. Standard vendors make 85% of their fee on easy first-pass claims and abandon the hardest 10%–15%. We often step in via a side-by-side audit or just take over neglected 90–120+ day AR.

Industry Insight

It costs a billing company approximately $25 in labor to work a complex appeal. On a $120 claim at a 6% fee ($7.20), they lose money fighting for you—so they let it age past timely filing.

Follow-Up

“Are they aggressively working your 90+ day AR, or just skimming the easy 30-day claims?”

Citation

HFMA: 65% of denied claims are never reworked due to vendor labor math, leaking 3%–5% of net practice revenue.

Answer

Great—if daily claims are smooth, don't disrupt them. Many clinics keep their primary vendor for daily billing while using DOS for standalone gaps like CAQH credentialing, 120+ day AR cleanup, or pre-visit eligibility.

Industry Insight

"Doing a good job" usually means cash feels steady, not that Net Collection Rate (NCR) or silent contractual write-offs have been audited.

Follow-Up

“Do they also handle provider credentialing, prior auths, and 120+ day AR under that same fee, or does that fall back on your office manager?”

Citation

AHIMA / MGMA: Top practices hit a 96%–99% Net Collection Rate, while the average clinic sits at 88%–91% due to buried write-offs.

Answer

One employee gives you one skillset and 40 hours a week, minus PTO and sick days. For a similar or lower cost, DOS gives you a cross-trained pod of CPC coders, AR collectors, and eligibility pros with zero downtime or payroll taxes.

Industry Insight

The "one-person RCM expert" is a myth. No single person masters ICD-10 modifiers (25, 59), LCD medical necessity rules, clearinghouse edits, and patient collections—and when they take vacation, your cash flow freezes 30 days later.

Citation

SHRM / BLS: One full-time U.S. biller costs $65,000–$74,000/year (fully burdened), and turnover costs 6–9 months of salary in ramp-up delays.

Answer

Pricing depends on your specialty, claim volume, average encounter value, and scope (percentage of net collections vs. flat-fee FTE support). We structure every deal so your recovered revenue more than pays for our fee.

Industry Insight

Never quote blind before knowing Average Revenue Per Encounter (ARPE). A 5% fee on $450 Cardiology claims is vastly different from $65 Medicaid Pediatrics claims.

Follow-Up

“To give you an exact number instead of a generic guess, what is your specialty, monthly claim volume, and primary bottleneck?”

Citation

HBMA / Becker’s: Industry RCM fees run 4%–8% of net collections, while managed FTE models save 35%–50% vs. domestic W-2 hiring.

Answer

DOS is headquartered in Farmington Hills, Michigan, backed by a blended global operations team. You get U.S. leadership, strict HIPAA governance, and direct accountability paired with a 24-hour revenue cycle engine.

Industry Insight

Practices don't hate global teams—they hate unmanaged teams. Our hybrid model gives you an overnight advantage: 5:00 PM clinic charges are scrubbed, coded, and submitted before 8:00 AM the next morning.

Citation

Everest Group / Black Book: 78%+ of U.S. health systems use blended onshore/global RCM teams to achieve 24-hour claim turnaround.

Answer

We enforce 100% HIPAA/HITECH compliance. Zero PHI is ever downloaded locally; our team works inside encrypted, IP-restricted virtual environments with MFA, disabled USB/print ports, screen-capture blocks, and continuous audit logs.

Industry Insight

Clinic breaches rarely come from hackers—they happen when an unmonitored biller exports an Excel aging report with patient SSNs onto a personal laptop. Our zero-local-storage architecture makes that impossible.

Citation

HHS OCR / IBM Security: Over 60% of clinic HIPAA violations stem from unencrypted local files or missing access logs.

Answer

Yes—we execute a formal HIPAA Business Associate Agreement (BAA) before accessing a single login or patient record, adhering strictly to 45 CFR § 164.504(e).

Industry Insight

We won't even let your staff send us an aging report for a free audit unless it's de-identified or covered under our mutual BAA and NDA.

Citation

45 CFR § 164.504(e): Federal law mandates written BAAs; violations carry HHS penalties from $137 to $68,928+ per incident.

Answer

Yes, we are 100% EHR/PMS agnostic. We log directly into your existing system—whether eClinicalWorks, Athenahealth, Epic, Tebra/Kareo, NextGen, AdvancedMD, Open Dental, or Cloud9—with zero software migration required.

Industry Insight

Doctors hate switching software more than losing money. Logging in as a virtual seat means your data never leaves your server, providers don't change a single click, and you retain 100% database ownership.

Citation

KLAS Research / AMA: Switching EHRs causes a 15%–25% productivity and cash drop in the first 90 days.

Answer

Yes, we manage end-to-end Medicare (PECOS), Medicaid, and commercial enrollment, CAQH ProView attestations, EFT/ERA setups, and re-credentialing—tracking expirations 120 days ahead so no provider ever gets billing-frozen.

Industry Insight

One missed 120-day CAQH re-attestation or lapsed DEA upload silently flips a provider out-of-network and holds 100% of claims.

Follow-Up

“Do you have any new providers waiting on payer effective dates, or current providers facing re-credentialing holds?”

Citation

NAMSS / MGMA: Payer enrollment takes 90–120 days, and an uncredentialed physician costs a clinic $7,500–$12,000/day in delayed revenue.

Answer

Yes, AR recovery is our core specialty. We segment aging buckets (31–60, 61–90, 91–120, 120+ days) and attack unpaid, underpaid, and stalled claims before timely filing windows close.

Industry Insight

Amateur billers work AR alphabetically. Veterans work AR by Payer Timely Filing Window × Dollar Value—because an 85-day UHC claim with a 90-day filing limit is far more urgent than a 200-day claim with a 365-day limit.

Citation

HFMA / MGMA: Best-in-class practices keep AR over 90 days below 10%–12%; once a claim passes 90 days, collection probability drops over 50%.

Answer

Yes, we run separate, compassionate patient AR workflows—using clear statements, SMS/email reminders, inbound support, and payment plans that recover deductibles while protecting your Google reviews.

Industry Insight

Chasing patients after they leave yields pennies. We pair polite post-visit follow-up with pre-visit eligibility so your front desk knows the exact remaining deductible before the patient walks out.

Citation

KFF / InstaMed: Patient responsibility now exceeds 30% of practice revenue, yet post-visit collection rates drop below 20%–30%.

Answer

Yes—we pair 24–48 hour appeal turnarounds with weekly root-cause CARC/RARC trend audits (fixing CO-16 missing info, CO-22 COB, CO-50 medical necessity, and CO-197 prior auths) to stop repeat rejections.

Industry Insight

Resubmitting a claim isn't denial management. Payers use AI engines to bulk-deny missing Modifier 25 or ICD-10 specificity in milliseconds; we feed payer denial patterns back into frontend scrubbing so you stop paying twice to collect once.

Citation

Change Healthcare / Experian: 41% of providers face denial rates over 10%; 86% are avoidable, and reworking one denial costs $25–$31 in clinic labor.

Answer

Yes, we verify benefits 48–72 hours before appointments—checking active coverage, copays, remaining deductibles, out-of-network rules, COB, PCP assignment, and CPT prior authorization requirements.

Industry Insight

Automated clearinghouse "real-time" checks lie—they say "Active Blue Cross" but miss that the patient's HMO PCP is assigned to another clinic or Medicare is secondary (MSP). Human verification stops number one front-end denials cold.

Citation

CAQH / HFMA: Front-end eligibility and authorization errors cause 40%+ of all initial claim denials.

Answer

Yes, our AAPC (CPC) and AHIMA (CCS) certified coders handle specialty ICD-10-CM, CPT, and HCPCS coding, E/M leveling, modifier linkage (24, 25, 59, 95), NCCI edits, and LCD/NCD compliance.

Industry Insight

Doctors constantly under-code Level 4 visits (99214) as Level 3 (99213) out of audit fear, or forget Modifier 25 on same-day procedures. Certified coding audits protect compliance while legally lifting encounter revenue 8%–15%.

Citation

CMS CERT / AAPC: Over 30% of physician E/M charts are under-coded or missing modifiers, costing $15,000–$40,000 per provider annually.

Answer

We offer modular, end-to-end healthcare operations built around your workflow. Whether you need full RCM or a single fix like 120+ day AR recovery, we audit your bottlenecks first and prescribe the exact scope.

Citation

Black Book Research: 82% of physician groups prefer modular, customized RCM workflows over rigid "all-or-nothing" contracts.

Answer

You actually gain more control. We work inside your EHR, 100% of payer EFTs go straight into your bank account, we enforce a 0% unapproved write-off rule, and you get weekly KPI dashboards.

Industry Insight

Ask them: “If your in-house biller writes off $4,000 as 'non-covered' this Friday, do you get an alert?” Having someone down the hall you can't audit isn't control—SLA transparency and zero unapproved write-offs is control.

Citation

MGMA: Clinics enforcing formal weekly/monthly RCM KPI reporting collect 9%–14% more net revenue.

Answer

That happens when vendors sell cheap labor with no U.S. oversight or specialty coding rules. DOS eliminates that risk with U.S.-managed quality control, a Free Billing Audit, and a 30-Day Trial so we prove our numbers first.

Industry Insight

Low-tier vendors fail because script-readers re-file denied claims three times without fixing the coding error—triggering CO-18 duplicate denials. Naming that exact failure proves DOS doesn't operate that way.

Citation

KLAS Research: 64% of RCM vendor terminations are caused by poor communication and unresolved root-cause denials, not price.

Answer

“I’ll send that right over. So I don’t spam you with a generic brochure, which 30-day fix would put the most cash back in your pocket right now: cleaning up 90+ day AR, stopping eligibility denials, or speeding up credentialing?”

Industry Insight

Generic brochures get a less than 10% open rate. Pivoting to a Free 120+ Day AR Sample Audit or Specialty Benchmark Sheet turns a brush-off into a discovery call.

Citation

RAIN Group: Pain-point-specific follow-ups generate a 3.4x higher response rate than generic company decks.