Medical Billing & Revenue Cycle Management
Stop Leaving Revenue on the Table.
MSM Consulting manages your entire billing operation — from eligibility verification and coding to claims submission, denial resolution, payment posting, and AR follow-up — so your practice collects every dollar it earns.
- 18+ Years in healthcare billing
- 50 States served nationwide
- ICD-10 Certified coders on staff
- 24–48h Typical claim submission turnaround
- Medical Coding (ICD-10/CPT/HCPCS)
- Claims Submission & Follow-Up
- Denial Management & Appeals
- Revenue Cycle Management
- Eligibility Verification
- Payment Posting (ERA/EOB)
- AR Aging & Collections
The Revenue Problem
Most Healthcare Practices Are Leaving Millions Uncollected
Billing errors, coding mistakes, missed denials, and poor AR follow-up are silent revenue drains that compound over time. Most practices don’t realize how much they’re losing until they audit their collections.
At MSM Consulting, we’ve spent 18+ years helping healthcare organizations — from solo practitioners to multi-site agencies — recover revenue they didn’t know they were losing, and build billing systems that protect every dollar going forward.
- 5–10% Average industry claim denial rate Source: MGMA
- $125B+ Lost annually to claim denials in the US Source: CMS/AMA estimates
- 65% Of denied claims are never resubmitted Source: HFMA
- 90 Days Average accounts receivable aging in many practices Source: Industry benchmarks
- Coding errors trigger denials and compliance risk simultaneously
- Unverified eligibility leads to unpayable claims after services are rendered
- Staff-managed AR aging leaves high-value old claims uncollected
- Missed payer timely-filing deadlines forfeit valid claims permanently
- No denial pattern analysis means the same errors keep recurring
The Complete Revenue Cycle — What We Manage
- Patient registration & demographic verification
- Insurance eligibility & benefits verification ← Revenue protection starts here
- Prior authorization management
- Medical coding — ICD-10, CPT, HCPCS
- Charge capture & fee schedule review
- Claims submission (EDI & paper)
- Claims follow-up & status tracking
- Denial management & appeals ← Most practices fail here
- Payment posting — ERA, EOB, IVR, portals
- Patient balance billing & collections
- AR follow-up & aging report management
- Compliance audits & reporting
Unsure How Much Revenue You're Losing?
We offer a free billing analysis — we’ll review your denial rate, AR aging, and collection ratio and tell you exactly where the leaks are.
Our Services
Complete Medical Billing Solutions
Every service is handled by experienced, certified billing specialists who understand the specific payer rules, coding requirements, and compliance standards for your provider type and specialty.
Medical Billing & Coding
Accurate ICD-10, CPT, and HCPCS code assignment by certified medical coders ensures your claims reflect the true clinical complexity of services — maximizing reimbursement while maintaining compliance with payer and regulatory guidelines.
Claims Submission & Tracking
We submit clean claims electronically via EDI within 24–48 hours of receiving complete documentation. Every claim is tracked through the payer’s adjudication process — with proactive follow-up on any claim that stalls or goes unacknowledged.
Insurance Eligibility Verification
We verify patient insurance coverage, benefits, copays, deductibles, and authorization requirements before services are rendered — eliminating the leading cause of claim denials and protecting your cash flow at the source.
Revenue Cycle Management (RCM)
End-to-end management of your complete revenue cycle — from patient registration and prior authorization through claim submission, payment posting, and final collections. We manage every touchpoint between service delivery and full payment receipt.
Denial Management & Appeals
We analyze every denial, identify root causes, correct errors, file formal appeals, and track each claim through to resolution. We also implement systematic fixes to prevent recurrence — reducing your denial rate over time, not just resolving individual claims.
Payment Posting (ERA / EOB / IVR)
We post all incoming payments accurately and promptly across all payment types — electronic remittances (ERA), explanation of benefits (EOB), IVR, live calls, and web portals — providing weekly and monthly reconciliation reports.
Medical Coding Audits
Our coding specialists conduct prospective and retrospective audits of your existing claims to identify undercoding, overcoding, and compliance risks — protecting you from payer audits while recovering revenue from underbilled services.
AR Follow-Up & Aging Management
We work your aged accounts receivable systematically — prioritizing high-value claims and approaching each aging bucket with payer-specific strategies. Our AR reports give you full visibility into outstanding balances by payer, age, and denial reason.
Billing Compliance & Reporting
We keep your billing practices aligned with current CMS guidelines, payer policies, and coding standards — reducing audit exposure, preventing overpayment recovery demands, and providing regular compliance reports for your records.
Specialties We Bill
Healthcare Organizations We Bill For
Different provider types have different billing codes, documentation requirements, and payer rules. Our team includes specialists in each of these areas — not generalists applying a one-size-fits-all approach.
Home Health Agencies
Hospice Providers
Physician Practices
Healthcare Staffing Agencies
DME / HME Suppliers
NEMT Providers
Behavioral Health Providers
Rehab & Therapy Providers
Adult Day Care Centers
Assisted Living Facilities
Outpatient Clinics
Specialty Pharmacies
Denial Management
Denied Claims Are Lost Revenue — Until We Recover Them
Industry data shows that 65% of denied claims are never reworked or resubmitted — meaning practices simply absorb those losses. MSM Consulting treats every denial as recoverable revenue until proven otherwise.
Our denial management process doesn’t just resolve individual claims — it identifies the patterns causing repeated denials and implements systematic corrections so your denial rate decreases over time.
- Receive and categorize denial by reason code and payer
- Conduct root cause analysis — coding, eligibility, authorization, or documentation
- Correct the underlying error and prepare supporting documentation
- Resubmit the corrected claim or file a formal payer appeal
- Track the resubmission through adjudication to confirmed payment
- Implement system-level fix to prevent recurrence of the same denial type
Top Denial Reasons We Resolve Daily
- Incorrect or missing ICD-10 / CPT codes
- Insurance eligibility expired or inactive at time of service
- Missing or expired prior authorization
- Timely filing deadline missed
- Coordination of benefits (COB) issues
- Duplicate claim submission
- Non-covered service or benefit exhausted
- Incorrect patient demographic or member ID
- Provider not credentialed with payer at time of service
- Missing clinical documentation or medical necessity
- EDI / electronic claim format errors (277 rejections)
- Bundling and unbundling errors (NCCI edits)
Payment Posting
Accurate Payment Posting Across Every Channel
Payment posting is more than recording deposits — it’s the foundation of your financial reporting, denial identification, and AR management. Inaccurate posting creates a cascade of downstream errors that distort your revenue picture.
Electronic Remittance Advice (ERA)
- We process electronic remittance files from all payers, matching payments and adjustments to individual claims — identifying underpayments, contractual adjustments, and payment variances that require follow-up action.
Explanation of Benefits (EOB)
- Paper EOBs are manually reviewed, digitized, and posted with the same accuracy and detail as electronic remittances — ensuring no payment goes unrecorded and no underpayment goes unnoticed regardless of format.
IVR, Live Calls & Web Portals
- We retrieve payment information via IVR systems, provider portal logins, and direct payer contacts — consolidating all payment data into unified weekly and monthly billing and AR reports for your finance team.
How We Work
Our Billing Process: From Encounter to Payment
A transparent, systematic process that eliminates billing gaps and keeps your revenue cycle moving at maximum efficiency.
1
Onboarding & System Integration
We begin with a full billing audit of your current process, integrating with your existing EHR or practice management system. We establish workflows, confirm payer setups, and identify any immediate revenue recovery opportunities in your existing AR.
2
Eligibility Verification (Pre-Service)
Before every patient encounter, we verify insurance coverage, benefits, copays, deductibles, and authorization requirements — catching eligibility issues before services are rendered, not after the claim is already denied.
3
Medical Coding & Charge Capture
Certified coders review encounter documentation and assign accurate ICD-10, CPT, and HCPCS codes — maximizing legitimate reimbursement while maintaining strict compliance with CMS and payer-specific coding guidelines.
4
Claim Scrubbing & Submission
Every claim passes through our internal scrubbing process — checking for coding errors, missing information, and payer-specific edits before submission. Clean claims are submitted electronically within 24–48 hours of receiving complete documentation.
5
Claims Tracking & Follow-Up
We monitor every submitted claim through the payer’s adjudication process — proactively following up on any claim that is not acknowledged, processed, or paid within expected timelines before filing deadlines are threatened.
6
Denial Resolution & Appeals
Denied claims are analyzed, corrected, and resubmitted or formally appealed within payer-specific deadlines. We document every denial by reason code and implement root-cause corrections to reduce future denial volume.
7
Payment Posting & Reconciliation
All payments are posted promptly and accurately, with payer underpayments flagged for follow-up. We reconcile deposits against posted payments and provide weekly and monthly financial reports including collection rates and AR aging.
8
Reporting, Analytics & Compliance
You receive regular performance reports covering collection rate, clean claim rate, denial rate by payer and reason, AR aging by bucket, days in AR, and compliance audit results — giving you full financial visibility at all times.
Already Have a Billing Team? We Can Supplement.
Many clients use MSM Consulting to handle overflow, denial management, or AR recovery while keeping internal staff for patient-facing billing tasks.
The Difference
In-House Billing vs. MSM Consulting
Most healthcare organizations underestimate the total cost — in time, money, and lost revenue — of managing billing in-house without dedicated specialists.
VS
Managing Billing In-House
- Staff spending hours on billing instead of patient care
- High denial rates due to coding errors and missed edits
- Denied claims not followed up — revenue simply abandoned
- AR aging past 90 days with no systematic recovery strategy
- Coding not updated with annual ICD-10/CPT changes
- No performance visibility — unclear what's collected vs. owed
- Staff turnover disrupts billing continuity and revenue flow
- Compliance violations discovered only during payer audits
Billing with MSM Consulting
- Clinical staff focused on care — billing fully offloaded
- Certified coders submit clean claims with minimal denials
- Every denial analyzed and pursued to resolution
- Systematic AR follow-up recovers aging revenue
- Annual coding updates applied automatically
- Weekly/monthly reports with full financial visibility
- Consistent billing performance regardless of staff changes
- Proactive compliance audits prevent violations before audits
Our Performance
Billing Results That Speak for Themselves
18+
98.2%
Average clean claim rate across client portfolio
43%
Average denial rate reduction after onboarding
180,000+
Claims processed annually across all clients
Our Billing Team
Certified Specialists Who Know Your Revenue Cycle
Medical billing requires more than software — it requires specialists who understand clinical documentation, payer rules, and compliance requirements across every provider type they bill for.
Devin Asante
Interim Chief Executive Officer
Devin Asante serves as the Interim CEO of MSM Consulting, where he leads the company’s national consulting operations with a focus on licensing, compliance.
Janet Brown
Program Director
Janet Brown is the Program Director at MSM Consulting, bringing over two decades of clinical and administrative leadership to healthcare operations, program development and regulatory compliance.
Marvin Pike
Quality Assurance
Marvin Pike is a results-driven Quality Assurance professional at MSM Consulting, specializing in regulatory compliance, performance evaluation, and process improvement across healthcare.
David Morgan
Director of Billing and Credentialing
David Morgan is the Director of Billing and Credentialing at MSM Consulting. He coordinates provider enrollment, payer contracting, and revenue cycle.
Home Health or Hospice Organization?
PDGM billing, OASIS coding, and RAP submissions have specialized requirements. Our home health billing specialists handle all of it.
Real Results
Client Revenue Recovery Stories
High Denial Rate Resolved — Collections Recovered
A home health agency with a 22% denial rate engaged MSM Consulting after months of revenue shortfalls. Our billing audit identified systemic OASIS coding errors and missing prior authorizations as the primary denial drivers.
We corrected the coding workflow, implemented pre-authorization tracking, and resubmitted 6 months of denied claims. Within 90 days, the denial rate dropped significantly and significant past-due revenue was recovered.
- Denial rate reduced · 6 months of revenue recovered · New billing workflow implemented
AR Aging Cleaned — Days in AR Reduced
A DME supplier had over $200,000 in claims sitting in AR over 120 days, with no systematic follow-up strategy. Staff were overwhelmed managing new claims and couldn’t work the aged backlog simultaneously.
MSM Consulting conducted a dedicated AR recovery project — working aging claims by payer and priority, filing appeals on denied claims still within timely filing, and recovering a substantial portion of the aged AR within 60 days.
- Significant aged AR recovered · Days in AR reduced · Ongoing RCM management established
Undercoding Identified — Revenue Per Visit Increased
A behavioral health group practice suspected their reimbursement rates were lower than they should be. MSM Consulting conducted a retrospective coding audit across 3 months of claims and identified widespread undercoding — providers were consistently billing lower-complexity E&M codes than documentation supported.
We corrected the coding patterns, trained clinical documentation staff on supporting higher-complexity codes, and filed corrected claims for the audit period.
- Revenue per visit increased · Corrected claims submitted · Staff documentation training completed
Client Testimonials
What Our Clients Say
Why MSM Consulting
Why Healthcare Organizations Choose MSM for Billing
Healthcare-Only Focus
We exclusively bill for healthcare providers — not restaurants, law firms, or retail businesses. Every process, every coder, and every workflow is built specifically around healthcare payer rules, coding standards, and compliance requirements.
Specialty-Specific Expertise
Home health PDGM billing, hospice billing, DME/DMEPOS, behavioral health, and physician practice billing all have unique requirements. Our team includes specialists for each — not generalists reading the same manual.
Full Transparency & Reporting
You receive weekly and monthly reports covering every key billing metric — collection rate, clean claim rate, denial rate, AR aging, and days in AR — with commentary on trends and action items. No black box billing.
Works With Your Existing Systems
We integrate with your current EHR and practice management software — Epic, Kareo, Brightree, MatrixCare, Homecare Homebase, AdvancedMD, and others. You don’t need to change platforms to work with us.
Compliance-First Approach
Every claim we submit is reviewed for compliance with current CMS guidelines, payer policies, and OIG fraud risk areas. We protect you from overpayment demands, audit findings, and compliance penalties before they happen.
True Partnership — Not a Vendor
We function as an extension of your team — attending billing meetings, training clinical staff on documentation, and escalating payer issues on your behalf. Our success is measured by your collections, not just our activity metrics.
Frequently Asked Questions
Answers to the questions healthcare administrators ask most before making a billing outsourcing decision.
Ans. Revenue cycle management (RCM) is the complete financial process healthcare organizations use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. It begins with patient registration and insurance eligibility verification, moves through medical coding and claims submission, and ends with payment posting, denial resolution, and accounts receivable follow-up. Effective RCM determines how much revenue a practice actually collects versus what it should be collecting — and most practices are underperforming significantly without realizing it.
Ans. The national average claim denial rate is 5–10%, but many practices experience rates well above that — particularly in home health, DME, and behavioral health where coding and documentation requirements are complex. MSM Consulting reduces denial rates through upfront eligibility verification before service, accurate ICD-10/CPT coding with payer-specific edits, proactive authorization management, and a systematic denial root-cause analysis process that identifies and eliminates recurring denial patterns rather than just resolving individual claims.
Ans. Medical billing outsourcing is typically priced as a percentage of net collections — generally 4–9% depending on specialty, claim volume, payer mix, and scope of services. Most practices find that outsourcing billing pays for itself through higher collection rates, faster reimbursement, and reduced administrative overhead. MSM Consulting provides custom pricing based on your specific organization and service needs. Contact us for a free analysis and quote.
Ans. Yes, and this is one of our core specialties. Home health billing under PDGM (Patient-Driven Groupings Model) requires accurate OASIS coding, proper episode grouping, RAP submissions, and management of the final claim billing sequence. Hospice billing involves unique revenue code requirements, physician certification management, and level-of-care billing. Our billing team includes specialists with dedicated home health and hospice experience who understand these requirements in detail.
Ans. MSM Consulting works with all major EHR and practice management platforms including Epic, Kareo, AdvancedMD, Brightree, MatrixCare, Homecare Homebase, and others. Our team adapts to your existing systems rather than requiring you to change platforms or invest in new software. We’ll confirm compatibility with your specific system during our initial consultation at no charge.
Ans. MSM Consulting targets 24–48 hour claim submission after receiving complete, accurate documentation from your clinical team. Faster claim submission accelerates your reimbursement timeline — every day of delay in submission is a direct delay in cash receipt. We monitor clean claim rate and submission turnaround as core performance metrics and report both to clients in regular billing reports.
Ans. Yes — AR management and aging claims follow-up is a core component of our revenue cycle management service. We work aged AR buckets systematically, prioritizing high-value claims and approaching each payer with strategies suited to their specific processes and timelines. Many practices have significant uncollected revenue sitting in 90–180 day AR buckets that staff simply haven’t had time to work. We provide weekly AR aging reports so you always have full visibility into outstanding receivables.
Ans. A billing compliance audit is a systematic review of your coding and billing practices against CMS guidelines, payer policies, and OIG risk areas. MSM Consulting conducts both prospective audits (reviewing claims before submission) and retrospective audits (reviewing historical claims) to identify overcoding, undercoding, documentation gaps, and compliance vulnerabilities. Our goal is to identify and correct issues proactively — before a payer or government auditor does — protecting you from recoupment demands and penalties.
Let MSM Consulting Protect Every Dollar You Earn.
Our billing specialists will audit your current revenue cycle, identify where you’re losing money, and build a customized billing plan to maximize your collections — starting immediately.