Billing & RCM
Rejections worked at speed instead of ended, verification done after a claim bounces, and sixty client clinics whose obligations you inherited. The fix goes upstream to the clinic that caused it.
Four things a billing operation loses hours to. Not a feature list: these are the places the same work gets done twice.
Claim rejections and resubmissions
Insurance verification
Coding accuracy
Aging receivables nobody chases
Each one takes the workflow as it runs today and works it end to end. Every one is labelled a concept, and every number in them is either sourced or marked a design target.
A billing operation measures itself on how fast it reworks rejected claims, which rewards being efficient at a problem instead of ending it. This is the transformation that groups rejections by cause, sends the fix upstream to the clinic, and keeps a human on every resubmission.
$83B
Annual staff time spent on routine administrative transactions
Eligibility is usually checked after a claim bounces, which is the most expensive possible moment. This is the transformation that verifies coverage when the appointment is made, tells the front desk in plain language what it found, and never quotes a patient a price a person has not approved.
$12.3B
Annual savings available from fully adopting electronic eligibility and benefits verification
Most practices start at stage one or two, because that is where the risk is cheapest to remove. You can stop after any of them, and the first slice is a fixed fee.
Practice Audit
A one-page list of what to fix first What it costsWorking Pilot
A working tool your staff can actually use What it costsBuilt and Live
A live tool and the keys to it What it costsScale Across Sites
Every location on one standard What it costsA billing operation is not the custodian. It already handles personal health information as an agent of the clinics it bills for, which means it inherits their obligations rather than holding its own. This work runs as a sub-agent under those same agreements, and each client clinic's agreement is confirmed before a check runs against its patients. How the roles work.
Will it work with your system? Your software vendor sets the ceiling, not the studio you hire, and the four systems these practices run differ by who is allowed to build at all. What each one actually allows.
It moves work upstream of the rejection. Claim rejections and resubmissions, insurance verification, coding accuracy and aging receivables are the four pressure points, and the first two are where the money is. Eligibility gets verified at the moment the appointment is booked rather than after a claim bounces, and rejections get grouped by cause so the fix goes back to the clinic that caused them.
That is the point of reading the pattern instead of working the queue. A billing operation that measures itself on rework speed is getting efficient at a problem rather than ending it. Grouping rejections by cause and sending the fix upstream to the clinic changes the number of claims that bounce at all, and a human stays on every resubmission.
Yes, and the moment of booking is the cheapest possible time to find out. Coverage is verified when the appointment is made, the front desk is told in plain language what was found, and no patient is ever quoted a price that a person has not approved. Checking after a claim bounces is the most expensive version of the same task.
It is the normal case rather than a complication. A billing operation typically serves client clinics running four or more different EMRs, with remittance files parsed into one worklist. The work is designed to sit across that spread rather than to assume one system, because consolidating everyone onto one EMR is not something a billing company can require of its clients.
Before anything touches a chart
Canadian data residency
Records and processing stay in Canada.
Privacy impact assessment first
Completed before any patient record is used.
PHIPA s.17 agent agreement
Written into the service agreement.
Zero data retention
Nothing is stored after processing or used to train models.
An audit log on every access
Every access to a record is logged.
A clinician approves
Nothing enters a chart without review.
These are commitments in every engagement, not badges on a wall. We are a studio, not a certified platform, so we will not show you a logo we have not earned. What we can put in writing is how the work is built, where your records live, who is accountable for it, and what goes in the contract before a single patient record is touched.
Run billing for clinics that expect a clean claim rate you cannot hit by hand? A free consult maps the rejection pattern, and what fixing it recovers.
The founder is on every engagement. Specialists join for the stage that needs them, never an account manager.