Medical billing
ClaimsGetting claims out and payments in: submission, rejections, posting and follow-up. A billing-only vendor starts when the charge arrives and stops when the remittance is posted.
Revenue Cycle Management Services for Medical Practices
We run the whole revenue cycle for independent practices, from the coverage check before the visit to the last open claim in AR, as one outsourced billing department inside the EHR you already use.
- One service, front end to AR
- 3 to 5% of collections, month to month
- Free RCM audit in 3 to 5 business days
Revenue cycle
Where the revenue cycle leaks
Revenue is lost in three places: before the visit, while the claim is built, and after the payer answers. Most practices only see the last one, because that is where the denials show up.
- 01
Before the visit: coverage and authorization
A terminated plan, a wrong member ID or a missing authorization is decided before the patient arrives. It shows up weeks later as a denial.
- 02
During the visit: coding and charge capture
Services performed but never charged, codes chosen by habit and modifiers added by reflex all leave money behind or invite review.
- 03
After the claim: denials and AR
Denials left unworked, appeals filed after the deadline and AR that ages past 90 days are where the earlier mistakes become write-offs.
- 04
Between vendors
When billing, credentialing and prior authorization sit with different people, problems fall into the gaps: a provider not yet enrolled, an authorization that expired, a denial nobody owns.
- 05
Reports that arrive late
A monthly summary tells you what happened six weeks ago. By then the filing windows on the problem claims are shorter.
Scope
What revenue cycle management covers
We run all seven stages as one service, so every problem has a single owner. Each stage links to the page that covers it in detail.
| Stage | What it covers | More detail |
|---|---|---|
| Front end | Eligibility and benefits before the visit, prior authorization, and estimates for self-pay patients | Prior authorization |
| Enrollment | Payer credentialing, CAQH upkeep, revalidation and Medicare Advantage panels | Provider credentialing |
| Mid cycle | Certified coding, charge capture review and claim scrubbing against payer edits | Medical coding |
| Claims | Submission, rejections, payment posting, secondary claims and patient statements | Medical billing |
| Denials | Every denial worked by reason code and appealed inside its deadline | Denial management |
| Aged AR | Claims past 90 and 120 days, underpayments and backlogs left by a former vendor | AR recovery |
| Reporting | Collection rate, days in AR, aging by bucket and denials by payer, live in Apex | Apex dashboard |
Definitions
Medical billing versus revenue cycle management
Revenue cycle management
The whole cycleEverything that decides whether the claim pays, before and after it exists: coverage, authorization, enrollment, coding, denials, aged AR and the reporting that shows where it leaks.
What to ask any vendor
ScopeAsk for the exclusion list in writing. A low rate that leaves denials, AR, authorizations or credentialing with your staff is a smaller service, not a cheaper one. See how Quilven prices the whole cycle.
What stays with your team
In the buildingThe work that needs someone in the building: front-desk check-in, patient balance conversations and chasing documentation from providers. Most practices keep their billing staff.
Operating rhythm
How the cycle is worked, day to quarter
A revenue cycle runs on a schedule, not on whoever has time this week. This is the rhythm we work to.
| Cadence | What we work | Why it matters |
|---|---|---|
| Every day | Rejections, eligibility for upcoming visits, new remittances | Rejections and coverage problems are cheapest to fix before a filing window shortens |
| Every week | Denials by reason code, expiring authorizations, unpaid claims past payer norms | Patterns show up within a week, while the next claims can still be fixed |
| Every month | Net collection rate, days in AR, aging by bucket, underpayments by payer | The numbers that show whether the cycle is healthy, by payer and by provider |
| Every quarter | Coding edits, fee schedule changes, payer policy updates | NCCI edits change quarterly, and payer policies change with little notice |
Source: CMS NCCI edits
2026
Rules that changed the cycle in 2026
Prior authorization deadlines
CMS-0057-FSince 1 January 2026, Medicare Advantage plans, Medicaid and CHIP programs and their managed care plans must decide standard prior authorization requests within seven calendar days and expedited ones within 72 hours, and give a specific reason for any denial. A prior authorization API follows from 1 January 2027.
Prior authorization in Original Medicare
WISeRA CMS model running from 1 January 2026 to 31 December 2031 adds prior authorization, or pre-payment review, for selected services in Original Medicare in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
The 2026 fee schedule
CMS-1832-FTwo conversion factors, $33.57 for qualifying alternative payment model participants and $33.40 for everyone else, and a 2.5 percent efficiency adjustment to work values on non-time-based codes. Contracts priced off Medicare moved with it.
Estimates for self-pay patients
No Surprises ActPatients who are not using insurance and book at least three business days ahead must get a good faith estimate. A bill $400 or more above the estimate can be disputed within 120 days of the bill's date.
The authorization rules are covered in full on prior authorization.
Source: CMS-0057-F fact sheet · WISeR Model · CY2026 PFS fact sheet · CMS good faith estimate guide · CMS bill dispute guide
Onboarding
How the switch to Quilven works
| Step | What happens |
|---|---|
| 1. Free audit | We review your aging totals and return a line-by-line recoverable estimate by payer in 3 to 5 business days. No patient data is needed to start. |
| 2. Agreement and access | A HIPAA business associate agreement is signed before any patient data is shared, then we take access to your EHR and clearinghouse. |
| 3. AR snapshot | Every open claim gets an owner on day one, including what a former vendor left behind. |
| 4. Live | New claims, rejections and denials move to us. Most practices are live within a few weeks, depending on system access and enrollment status. |
| 5. Reporting | Apex shows the collection rate, AR aging and denials by payer as the work starts. |
Leaving another billing company? Read how to switch billing companies without losing money, check your current contract with the billing contract clause checker, and see how to get out of an auto-renewing billing contract.
Comparison
Before and after working with Quilven
A process comparison, not a promise of outcome. It shows what changes in how the cycle is run.
| Area | Before | With Quilven |
|---|---|---|
| Ownership | Billing, credentialing and prior authorization split between staff and vendors, with gaps between them. | One service owns every stage, and each problem has a named owner. |
| Eligibility | Coverage checked at booking, or after the denial. | Coverage verified before each visit, working with your front desk. |
| Authorizations | Tracked on a spreadsheet and expiring between visits. | Requirements checked at scheduling, and expiry dates tracked against the next visit. |
| Coding | Codes chosen by habit, edits found by the payer. | Certified coders review the note and check edits before the claim leaves. |
| Denials | Worked when someone has time, appealed late or not at all. | Worked by reason code every week and appealed inside each deadline. |
| Aged AR | Claims past 90 days written off without a documented reason. | Every aged claim paid, appealed or written off with a reason. |
| Reporting | A monthly summary, weeks after the month closed. | Live numbers in Apex, by payer and by provider. |
Which of these applies to your practice is a question the audit answers. Request the audit.
Case study
Where the $5,500 was hiding
One AR recovery engagement, at a family medicine practice in Minnesota. Shown for method: most of the losses started at the front end, before the claim existed. Individual results vary. One engagement is not a forecast.
We reviewed 245 claims. The rejection queue had no owner, and some claims in it had waited close to a year.
Billed charges in that queue came to roughly $40,000 to $50,000, none of it being worked.
Most of the damage started before the claim was built. Stale coverage, incorrect member IDs and skipped eligibility checks at the front desk caused 70% of the denials.
Not everything could be reopened. On most of the affected claims, a commercial payer's 90-day window had already passed with no proof of submission on file, so appeals were not possible.
What came back was about $5,500, paid on 50 to 55 claims, most of it within 45 to 50 working days.
In their words
What the physician said
What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
I appreciate the professionalism, the courtesy, the knowledge.
After the audit the practice changed how it runs: eligibility verified before arrival, no more walk-ins, every patient checked the night before.
Pricing
What Quilven costs
The whole cycle is priced as one: 3 to 5 percent of collections with a $500 monthly minimum, the same for every specialty. Aged AR projects and credentialing-only work are priced separately. You can see pricing in full.
AR recovery
12 to 15%
of the recovered amount
No fee on what is not recovered. Where a practice lands in the range depends on claim volume, age of the inventory, and payer mix.
Medical billing
3 to 5%
of collections by monthly volume
A $500 monthly minimum applies. The rate moves with monthly volume, not with headcount on your side.
Credentialing
$150 to $200
per payer application
$200 per application, or $150 each on larger batches. Included in the billing percentage for billing clients.
Fit
Fit with your EHR
Outsourcing the revenue cycle does not require a system swap. We integrate with 30+ EHRs and practice management systems and work inside the one you already have. No data migration, no parallel system, no change to how your staff enters a charge or checks a patient in. If your team is trained on your current software, that training stays valid.
This matters because the usual objection to outsourcing the revenue cycle is that it turns into an implementation project. It does not here. Quilven is a managed service, not software. There is no proprietary platform you are asked to adopt and no license to renew, so the engagement can start on the claims and AR you already have rather than after a build-out.
What you do get is visibility. Apex is our client dashboard, and it shows in real time:
- Net collection rate
- AR aging by bucket
- Denial reasons by payer
- Credentialing pipeline
Apex reads the work we are doing in your system. It is a window, not a replacement, so if the engagement ends your records and workflows are exactly where they were.
Company
Who Quilven is
Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.
Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 to $200 per payer application.
The entry point is a free RCM audit. It takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.
We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick and works from 159 4th Ave N, Suite 100, Nashville, TN 37219. The entity is registered in Wyoming. Reach us at (202) 490-9406 or info@quilven.com.
Fit
Who this is for
Independent, physician-owned practices with 3 to 25+ providers that want one owner for the whole revenue cycle. Solo practices are welcome too.
It suits practices running billing in-house with one or two people, practices leaving a billing company, and groups adding providers faster than enrollment keeps up. If you want to keep your biller, see how outsourcing AR works while your biller stays.
It is not for hospitals, FQHCs or enterprise health systems.
At a glance
Revenue cycle management service facts
- Service
- Managed revenue cycle management for independent practices
- Covers
- Eligibility, prior authorization, credentialing, coding, claims, denials, AR recovery, reporting
- Delivery model
- Managed service, not software, not an EHR
- Systems
- 30+ EHR and practice management integrations, no data migration
- Practice size served
- 3 to 25+ providers, independent and physician-owned; solo practices welcome
- Pricing
- 3 to 5% of collections by monthly volume, $500 monthly minimum, month to month
- Entry point
- Free RCM audit, 3 to 5 business days, recoverable estimate by payer
- Reporting
- Apex dashboard: net collection rate, AR aging by bucket, denial reasons by payer, credentialing pipeline
- Compliance
- HIPAA business associate agreement signed before any patient data is shared
- Area served
- United States
FAQ
Revenue cycle management questions
Billing gets claims out and payments in. Revenue cycle management covers everything that decides whether a claim pays: coverage checks, prior authorization, credentialing, coding, denials, aged AR and reporting. Quilven runs all of it as one service.
3 to 5 percent of collections, set by monthly volume, with a $500 monthly minimum, the same for every specialty. Credentialing is included for billing clients. Aged AR projects are priced at 12 to 15 percent of what is recovered.
The free audit takes 3 to 5 business days. Most practices are live within a few weeks, depending on system access and the enrollment status of each provider.
Yes. A HIPAA business associate agreement is signed before any protected health information is exchanged, and it covers every person who touches your data.
No. We work inside the system you already use, across 30+ EHR and practice management integrations. Your licenses stay in your name and your data stays yours.
No, and most practices keep them. Front-desk eligibility, patient balances and chasing documentation stay with your team. Submission, coding review, denials, AR follow-up, prior authorization and credentialing can move to us.
Sources
Sources
Checked 17 October 2026. Coverage policies and code rules revise without much notice, so confirm the current version before you rely on one.
- CMS, Interoperability and Prior Authorization final rule (CMS-0057-F) fact sheet
- CMS Innovation Center, WISeR (Wasteful and Inappropriate Service Reduction) Model
- CMS, CY2026 Physician Fee Schedule final rule fact sheet (CMS-1832-F)
- CMS, What is a good faith estimate
- CMS, Dispute a medical bill
- CMS, National Correct Coding Initiative (NCCI) edits
Next step
Start with a free RCM audit
The audit takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, plus the repeating root causes behind your denials. We only need aging totals to begin. No patient data, no contract, no obligation to work with us afterward. If your aging is healthy we will tell you that.
Answer three questions below and book a line-by-line audit of your revenue cycle.
Where it leaks
Oldest claim
Practice size
Your details
Where is the money leaking right now?
Pick the one that hurts most. We start there.
How old is your oldest unpaid claim?
A round number is fine. We verify it in the audit.
How big is the practice?
Just you, or a group. Either is welcome.
Last bit — where do we send the report?
No patient data. We only need aging totals to start.
(202) 490-9406 · info@quilven.com · Book 15 minutes