BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM Medical coding
🟢 Patient Financial Services
Maximizing Revenue Integrity with Accurate & Compliant Medical Billing Solutions
Simplifying Medical Billing with Accuracy & Efficiency
Schedule a Call45 Days
Total Appointments Scheduled
95%
Clean Claim Rate
85%
Patient Collection Rate
Overview
Reliable & Transparent Financial Services for Patients and Providers
ASP-RCM Solutions specializes in accurate medical billing, seamless claims processing, and practical financial management to support patients and healthcare providers.
Comprehensive Medical Billing & Revenue Cycle Management (RCM)
We handle the medical billing, from charge capture and claim submission to payment posting and follow-up. Our structured approach minimizes errors, reduces rejections, and maximizes reimbursements for healthcare providers.
Insurance Verification & Pre-Authorization
Before service delivery, we conduct real-time eligibility verification (270/271 transactions) and pre-authorization processing to confirm coverage details, co-pays, deductibles, and out-of-pocket expenses. Our payer connectivity solutions help reduce claim rejections due to coverage issues.
Denial Management & Appeals Processing
We provide denial tracking, root cause analysis, and appeal submission to minimize revenue loss. Our structured Denial Management Workflow (DMW) includes automated follow-ups, reconsideration requests, and Level 1 and Level 2 appeal submissions based on Explanation of Benefits (EOB) and Claim Adjustment Reason Codes (CARC).
Patient Financial Assistance & Payment Plans
Our financial counselors assess patient eligibility for Sliding Fee Scale (SFS) programs, charity care, and government-sponsored plans such as Medicaid & Medicare. To improve self-pay recoveries, we offer structured patient payment plans, Health Savings Account (HSA) integration, and point-of-service (POS) collections.
Regulatory Compliance & Accurate Coding
We ensure compliance to HIPAA (Health Insurance Portability and Accountability Act), CMS (Centers for Medicare & Medicaid Services) regulations, and payer-specific guidelines. Our compliance checks include National Correct Coding Initiative (NCCI) edits, Local Coverage Determinations (LCDs), and Medicare Secondary Payer (MSP) validation to prevent fraud, waste, and abuse.
Operations
End-to-End Medical Billing & Financial How It Works
With a focus on revenue integrity, cash flow optimization, and payer coordination, our billing solutions integrate with Electronic Health Records (EHR), Clearinghouses, and Practice Management Systems (PMS) for seamless financial transactions.
Claim Scrubbing & Submission
We utilize payer-specific edits, National Provider Identifier (NPI) validation, and Place of Service (POS) code mapping to ensure clean claim submissions (837P/837I transactions) and reduce rejections from Medicare, Medicaid, and commercial payers.
Payment Posting & Reconciliation
Our team processes Electronic Remittance Advice (ERA 835) and manual payment postings with auto-reconciliation to General Ledger (GL) and Payment Variance Analysis (PVA) to identify underpayments and prevent revenue loss.
Accounts Receivable (A/R) Management & Collections
We perform aging analysis, payer follow-ups, and timely secondary & tertiary billing to maintain a low Days Sales Outstanding (DSO) and reduce A/R aging beyond 90 days. Our Key Performance Indicators (KPIs) tracking helps providers improve collections.
Charge Capture & Coding Compliance
Our certified coders (CPC, CCS, RHIT) perform Modifier Validation, Medical Necessity Checks, and Risk Adjustment Factor (RAF) calculations to ensure accurate coding and maximize reimbursements.
Patient Billing & Support Services
We offer dedicated patient support for billing inquiries, payment disputes, and refund processing through IVR-based helplines, secure patient portals, and 24/7 customer service teams to enhance patient experience.
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have securely received your patient and encounter data, we code, review, and submit claims to payers. We manage appeals and denials, track payments, and provide regular updates. Our process is designed to be efficient and transparent.
Our certified coders and billing specialists review every claim carefully. We use quality‑control checks, regular coding audits, and payer‑specific validation to reduce coding errors and the risk of denials.
Our denial‑management team reviews each denied claim to identify root causes. We correct issues, resubmit claims promptly, and, when needed, pursue appeals with payers to maximize reimbursement.
We offer flexible pricing tailored to client needs — including fixed fees, per‑claim pricing, or percentage‑of‑collections models depending on volume and services required. Contact us for a custom quote.
Yes. We specialize in seamless transitions from in‑house systems or other vendors. To ensure secure data migration, our team works closely with you and provides training as needed.
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