Revenue Cycle Management (RCM)
At Annova Solutions, our Revenue Cycle Management (RCM) services are designed to optimize financial performance and streamline operational workflows for healthcare organizations. Leveraging certified expertise, advanced technology, and industry-driven best practices, we ensure end-to-end management of the revenue cycle with precision and compliance. Our services encompass E&M Coding, Specialty CPT Coding, and Denial Management, focusing on minimizing claim rejections, improving payment integrity, and maximizing reimbursements. With solutions tailored to meet payer, provider, and regulatory requirements, we empower healthcare organizations to achieve operational excellence and financial sustainability.
From accurate coding and claim submissions to denial resolution and revenue recovery, we transform RCM processes, enabling seamless cash flow and enhancing the overall patient-provider experience.
Charts coded in one season
Certified Coders
Coding Accuracy
Comprehensive Services
E&M Coding
Our Evaluation and Management (E&M) Coding services ensure the precise classification of patient visits and encounters. By adhering to CMS and payer-specific guidelines, we deliver accurate documentation that reflects the complexity of care provided. Our certified coders leverage advanced tools to identify gaps, ensure compliance, and optimize reimbursements while minimizing audit risks.
Specialty CPT Coding
We provide specialized CPT coding expertise across diverse medical disciplines, including radiology, cardiology, orthopedics, and surgery. Our team ensures precise coding for complex medical procedures, helping healthcare organizations reduce denials, enhance compliance, and maximize revenue.
Denial Management
Our Denial Management solutions focus on identifying root causes of claim rejections and implementing proactive strategies to resolve issues. Services include denial analysis, coding-driven appeals, claims re-submission, and preventive measures to reduce future denials.
Other Comprehensive Services
- Radiology Coding: Accurate and compliant coding for diagnostic and interventional radiology services.
- Surgical Coding: Expertise in coding complex surgical procedures across multiple specialties.
- Modifier Usage: Precision in applying procedural modifiers to prevent claim rejections and optimize reimbursements.
- Accounts Receivable (AR) Management: AR calling, revenue recovery strategies, and data-driven insights for optimizing cash flow.
- Payment Integrity Services: Certified Code Review, Fraud, Waste, and Abuse (FWA) Detection, and corrective action plans.
Supporting Services
- Patient Scheduling & Appointment Management to streamline workflows and reduce no-shows.
- Clinical Documentation Improvement (CDI) to enhance documentation quality for compliance.
- Clearinghouse Offerings: EDI, Claim Scrubbing, ERA, and Coordination of Benefits (COB) Verification.
- Appeals Management for effective and timely resolution of denied claims.
- EHR Integration to streamline RCM workflows and improve operational efficiency.
- Provider Education and Training for accurate documentation and reduced revenue leakage.
Key Benefits
Optimized Reimbursement & Revenue Integrity
We ensure accurate medical coding, claim submissions, and compliance-driven audits to minimize revenue leakage. Our structured approach to denial prevention and appeals management helps maximize reimbursements and financial stability.
Reduced Denials & Faster Claim Resolutions
With AI-driven denial analytics and proactive claim validation, we help prevent errors before submission. Our root-cause analysis and payer-specific compliance strategies significantly reduce denials and accelerate payment cycles.
Regulatory Compliance & Audit Readiness
We adhere to ICD-10, CPT, HCPCS, and CMS guidelines, ensuring that all claims meet regulatory requirements and industry best practices. Our audit-ready documentation and fraud detection tools help mitigate compliance risks and potential penalties.
Improved Accounts Receivable (AR) Management
Our real-time AR tracking and automated payer follow-ups reduce outstanding balances and improve cash flow. By focusing on claims resolution and payer negotiations, we optimize revenue recovery and operational efficiency.
Advanced Analytics for Financial Performance
Leveraging predictive analytics, payer trend analysis, and performance benchmarking, we provide data-driven insights that enhance contract negotiations, revenue forecasting, and strategic financial planning.
Who We Serve
At Annova Solutions, we serve a diverse range of healthcare organizations, each with unique needs:
FAQs
Annova Solutions optimizes the revenue cycle by leveraging AI-powered claims scrubbing, automated coding validation, and real-time financial tracking. Our integrated RCM workflows ensure faster claim processing, reduced administrative burden, and streamlined reimbursement cycles. By incorporating automated eligibility verification, coding accuracy checks, and denial prevention measures, we help healthcare organizations achieve higher efficiency and faster revenue realization.
We adopt a proactive approach to claim management, ensuring pre-submission validation, compliance checks, and payer-specific coding adherence. Our denial prevention framework includes automated claim edits, real-time eligibility verification, and AI-driven analysis of payer trends to significantly reduce rejections. Additionally, our denial resolution team utilizes structured appeals processes and root-cause analysis to recover lost revenue efficiently.
We maintain strict adherence to ICD-10, CPT, HCPCS, and CMS guidelines, ensuring that all coding and billing processes align with state, federal, and commercial payer requirements. Our compliance-first approach includes real-time policy updates, payer-specific documentation audits, and regulatory reporting to safeguard against non-compliance risks, audits, and reimbursement penalties. Additionally, our fraud detection tools monitor for coding discrepancies and billing anomalies to prevent financial and legal risks.
Effective AR management is critical to sustaining cash flow and minimizing aging accounts. Annova Solutions integrates real-time AR tracking, automated follow-ups, and structured payment reconciliation to ensure faster collection cycles and reduced outstanding balances. Our payer negotiation expertise and customized financial analytics help providers optimize collections, reduce revenue loss, and improve overall financial stability.
We align our RCM strategies with value-based care initiatives, ensuring accurate risk-adjusted reimbursements, HCC coding optimization, and quality measure tracking. By integrating data-driven population health insights, performance benchmarking, and compliance-driven documentation, we help payers, providers, and ACOs achieve shared savings, enhance care coordination, and optimize financial sustainability under value-based contracts and alternative payment models.