Stop Denials with AI-Powered RCM Solutions: Reclaim Your Revenue
You didn’t go into healthcare to become a collections agency. Yet every week, your team spends 40+ hours on AI Denial Prevention and chasing slow payers. Our intelligent RCM solutions fix that—permanently. We pair battle-tested technology with human expertise to stop the cycle, so cash flows faster and your team can focus on patients.
We fix that — permanently.
At SimplifyingRCM, we pair battle-tested AI with human revenue experts who’ve lived in your shoes. The result? A revenue cycle that doesn’t just survive — it thrives.
The Hidden Cost of a Broken Revenue Cycle
| What You Lose | Real-World Impact |
|---|---|
| $38 average cost per denied claim | One 50-provider practice = $190 k/year in rework alone |
| 45-day average payment delay | Ties up $1.3 M in working capital for a $10 M practice |
| Staff burnout | 62 % of billers report “high stress” (MGMA 2024) |
These aren’t hypotheticals — they’re the math we run on every new client.
Why Our Approach Actually Works
Most vendors sell tools. We deliver outcomes.
| Traditional RCM | SimplifyingRCM |
|---|---|
| Reactive firefighting | Predictive prevention |
| Siloed software | Single source of truth |
| Generic rules | 50 k+ payer-specific edits updated daily |
| “Here’s your login” | White-glove onboarding + dedicated revenue coach |
Our Core Solutions (Pick One or Stack Them)
1. Stop Denials Before They Start
AI-Powered Denial Prevention
The old way: Wait for the denial letter, then scramble. Our way: Prevent the denial before the claim leaves your office.
How It Works in Real Life
Your coder enters a complex knee arthroscopy. Our AI instantly:
- Scans the op-note with natural language processing
- Cross-checks against UnitedHealthcare’s latest bundling rules
- Flags: “Add modifier -59 to CPT 29881 or risk $1,800 denial”
- Your coder clicks “Apply” — claim sails through.
Proven Results (averaged across 127 clients, 2024–2025)
| Metric | Before | After | Improvement |
|---|---|---|---|
| Preventable denials | 18 % | 2.7 % | 85 % ↓ |
| Days in A/R | 62 | 37 | 40 % faster |
| First-pass pay rate | 71 % | 89 % | 25 % ↑ |
2. Get Paid 30–45 Days Faster
Revenue Acceleration Suite
No more “Where’s my money?” We shrink every bottleneck:
- 24-hour claim submission (99 % electronic)
- AI predicts exact payment date (±3 days)
- Auto-escalates aging claims to the right payer rep
Result: Cash flow you can actually forecast.
3. Turn Patients into Payers (Without the Awkward Ask)
Patient Financial Experience Platform
Patients owe $1,200 on average post-visit. Our platform makes paying easy:
- Text-to-pay in under 10 seconds
- Pre-visit cost estimates accurate to ±8 %
- Auto-payment plans (0 % interest)
Outcome: 50 % ↑ in patient collections, 65 % ↓ in billing calls.
4. Sleep Easy Knowing You’re Compliant
Compliance Intelligence System
Regulations change weekly. We update daily.
- HIPAA, Stark, AKS — all baked in
- Audit-ready documentation in one click
- Risk score dashboard (think credit score for compliance)
Result: 90 % ↓ compliance denials, zero surprise audits.
5. See Your Money Blind Spots in Real Time
Performance Optimization Analytics
| Insight | Action |
|---|---|
| Cardiology losing $42 k/month on under-coded E/Ms | Train providers → recapture revenue |
| Payer X pays 18 days late | Renegotiate contract → +6 % reimbursement |
Custom dashboards. Drill-down reports. Export to PowerPoint in one click.
6. One Platform to Rule Them All
Integrated Technology Platform
No more copy-paste between 5 systems. Cloud-native, API-first, mobile-ready.
Integration time: 14 days average (vs. 3–6 months for legacy systems)
Built for Your World
| Practice Type | Tailored Superpower |
|---|---|
| Multi-Specialty | Cross-specialty profit tracking |
| Surgical Centers | Implant cost recovery + global period automation |
| Behavioral Health | Telepsychiatry + collaborative care billing |
| Health Systems | Enterprise dashboards + centralized compliance |
Your 3-Phase Journey to Revenue Freedom
| Phase | What Happens | Deliverable |
|---|---|---|
| 1. Assessment (Week 1) | We map your current chaos | 27-page gap analysis + ROI projection |
| 2. Deploy (Weeks 2–6) | Plug-and-play integration | Live system + trained team |
| 3. Optimize (Ongoing) | Monthly tune-ups | 3–7 % additional revenue lift |
Proof in the Numbers
| Metric | Industry Avg | SimplifyingRCM Clients |
|---|---|---|
| Net Collection Rate | 92 % | 98.4 % |
| Days in A/R | 48 | 31 |
| Cost to Collect | 4.2 % | 2.1 % |
Source: MGMA 2024 + internal data (n=142 practices)
Frequently Asked Questions
How long until I see results?
Most clients hit breakeven in 60–90 days. Denial prevention shows ROI in week 3.
Is my data safe?
SOC-2 Type II certified, encrypted at rest + in transit. Annual penetration testing.
What if we’re already using Epic?
Native bi-directional API. No rip-and-replace.
How much does it cost?
Starts at 2.9 % of collections (all-in). Schedule your assessment for an exact quote.
Ready to Stop Losing Money You’ve Already Earned?
Next 30 minutes could add $100 k+ to your bottom line.
Includes:
- Complimentary denial audit
- Custom ROI calculator
- Live demo of your biggest leak
Limited to 5 practices per week.