We provide customized hospital revenue cycle management solutions built around your hospital’s operational and financial goals. Our comprehensive hospital billing services include accurate billing and coding, AR recovery and follow-up, credentialing, insurance verification, expert use of leading EHR and practice management systems, and patient engagement solutions. As a dedicated hospital billing company serving healthcare facilities across the USA, we handle every step of the revenue cycle so your clinical staff can focus on patient care.
— Key Performance Indicators
Collection Ratio
Reduction in AR
First Pass Clean Claims Rate
Revenue Increase
Denial Rate
Days Turnaround Time
— Who We Serve
Here is how we handle the ones that require specialist configuration:
Receive cost-based Medicare reimbursement under the Rural Hospital Flexibility Program, not DRG-based IPPS. We configure CAH billing around cost report preparation, charge master accuracy, and interim payment reconciliation.
Bill under the Patient-Driven Payment Model since 2019. We handle ICD-10 classification across all five PDPM clinical components, MDS submission, and functional score assessment for accurate per-diem payment.
Require correct APC assignment and modifier application across high-volume outpatient procedure claims. We configure ASC billing distinctly from hospital outpatient department workflows.
Require billing for psychiatric inpatient stays, partial hospitalization programs, and intensive outpatient services under both Medicare and Medicaid payer rules. We handle all three settings correctly.
Tied to the 25-day average length-of-stay threshold. We configure LTACH billing workflows separately from standard inpatient DRG billing.
Cost Analysis
Maintaining an in-house billing department of 15-25 staff costs $825,000 to $1,875,000 in annual payroll alone, before benefits, training, and technology.
CMS data shows in-house operations average 8-14% denial rates and 45-65 AR days. Outsourcing typically runs at 30-50% of that cost while bringing denial rates under 4%. For a hospital collecting $10 million annually, that gap represents $800,000 in recovered revenue.
— Step-by-Step Coverage
In the US, hospitals deal with billing rules from over 1,600 insurance payers and decades of government regulations. Medicare rules alone span more than 130,000 pages, making hospital billing complex and time-consuming. Dastify Solutions handles these complexities for you. Here is exactly how we support your revenue cycle at every step.
| Process Step | Inpatient Billing Services | Outpatient Hospital Billing Services |
|---|---|---|
| Appointment Scheduling and Patient Registration | Schedule inpatient admissions, confirm identity, gather insurance details, and collect deposits if needed | Schedule outpatient visits or procedures, verify patient information and insurance coverage, provide upfront cost estimations, and collect co-pays |
| Insurance Verification and Prior Authorization | Verify eligibility for admission, check limits, secure prior authorization for surgeries or extended care, and confirm medical necessity to prevent coverage denials | Confirm coverage for procedures and imaging, and obtain prior authorization as needed |
| Charge Capture and Revenue Integrity | Record all inpatient services accurately through hospital charge capture services, update the CDM and CMI to prevent missed charges, and collaborate with providers to ensure accurate hospital CDI services and DRG grouping | Record all outpatient services clearly, match charges accurately to CPT/HCPCS codes, and double-check entries to prevent missed charges |
| Medical Coding | Assign ICD-10-CM for diagnoses, ICD-10-PCS coding services for inpatient procedures, and group cases into DRGs for Medicare hospital billing services | Assign ICD-10-CM codes for diagnoses and CPT/HCPCS codes for procedures and apply the correct modifiers for compliance |
| Claim Preparation and Submission | Generate UB-04 claims with proper MS-DRG optimization services applied, scrub for errors, and submit within timely filing limits | Prepare UB-04 or CMS-1500 claims, verify with claim scrubbers, and submit clean claims promptly to minimize denials |
| Payment Posting and Reconciliation | Post payments from ERA/EOB, match deposits, apply adjustments, and handle secondary claims for inpatient charges | Post payments and patient co-pays quickly, reconcile deposits, and manage follow-ups on partial payments |
| Denial Management & Appeals | Use the IMMP process for inpatient hospital claim submission services denials, resubmit corrected claims, and file appeals or peer-to-peer reviews | Analyze root cause for outpatient denials, correct coding or documentation issues, and manage appeals to recover revenue |
| AR Follow-Up & Collections | Focus on high-value inpatient accounts through hospital accounts receivable services, track aging buckets, and follow up on unpaid balances to reduce AR by up to 35% | Monitor large volumes of outpatient accounts, use automated reminders, and follow up promptly on overdue balances |
| Reporting & Insights | Hospital billing analytics services: AR Aging Reports, DRG Performance Analysis, Denial Trends, Revenue Recovery Metrics, Custom Reports | Outpatient Visit Volume Dashboard, Clean Claim Rate, Denial Trends, Collection Efficiency Metrics, Custom Reports |
— Revenue Leakage
Here is what we see most often when hospital systems come to us, and what we do about each one.
Claims stuck in 90+ day AR draining cash flow
Our AR specialists follow up on every unresolved claim using payer-specific escalation protocols, pulling high-value inpatient accounts out of the 90+ day bucket within the first quarter
DRG downgrades and POA-related denials cutting inpatient revenue
Our AAPC-certified coders review every inpatient admission for CC and MCC documentation completeness before coding, protecting the DRG assignment that the clinical record supports
Condition Code 44 errors triggering CMS audit flags
We apply Condition Code 44 correctly when inpatient admissions are reclassified to outpatient observation status, rebilling under the appropriate APC payment structure and tracking reclassification rates monthly
340B split billing compliance gaps creating OIG audit exposure
We configure hospital billing for 340B split billing workflows that maintain correct inventory attribution, apply Medicaid exclusion logic correctly, and generate audit documentation that demonstrates compliance.
RAC records requests with 45-day response windows
We maintain hospital billing audit services documentation for every claim, linking each ICD-10 and MS-DRG assignment to the specific clinical documentation that supports it, so audit responses go out complete and on time.
— Clinical Documentation & Audit Defense
Under Medicare’s IPPS, each admission is assigned an MS-DRG that determines payment regardless of actual resource utilization. The difference between a base payment and an uplift comes down to documented complicating and major complicating conditions. A sepsis admission documented with septic shock, causative organism, and acute respiratory failure can generate $6,000 to $12,000 more than the same admission without those specifics.
— What Our CDI Specialists Do
Our CDI specialists review every admission for CC and MCC completeness, generate physician queries for missing specificity, and track MCC capture rate monthly.
When a RAC issues a records request, the response window is 45 days. Late responses result in automatic recoupment. We maintain RADV-ready documentation for every HCC-coded encounter and prepare complete audit response packages within the payer’s submission window.
— Drug Program Compliance
— BPCI-A & DSH Programs
We configure BPCI-A tracking workflows that monitor episode spending in real time, identify post-acute utilization patterns pushing episodes over target price, and ensure reconciliation payments are captured and reconciled accurately.
— Regulatory Compliance
We maintain full alignment with U.S. hospital billing laws and healthcare regulations through continuous staff training, quarterly compliance audits, and billing workflows built specifically around current CMS and payer requirements.
— No Obligation
Find out how to speed up payments and reduce unpaid claims at no cost. Our free AR assessment identifies what is slowing down your hospital billing system and provides clear steps to address it.
Choose Your Plan
Transparent Pricing with no hidden Cost
Starter
For Solo & Small Practices
of collections
Most Popular
Growth
For Group Practices & Clinics
of collections
Enterprise
Hospitals & Large Systems
Volume-based pricing
— Proven Expertise in
50+ EHR/EMR/PMS
— Trust & Compliance
Our compliance record across every client engagement is maintained through continuous staff training, regular internal audits, and billing workflows built specifically around CMS and payer requirements.
— Our Difference
— Common Questions
Our hospital medical billing services help you submit accurate claims and get paid faster. We understand UB-04 forms, DRG coding, and payer rules across all major payers. By managing front-end, mid-cycle, and back-end tasks, we reduce your staff’s workload, cut overhead costs by up to 50%, and help you recover revenue that would otherwise be lost to denials and underpayments. Hospitals that outsource hospital billing to a dedicated RCM team typically see denial rates drop from 8-14% to under 4% within the first 90 days, and AR days move from the 45-65 range toward the 25-35 day range within the first 90 days of engagement.
Achieve up to 35% more revenue with hospital revenue cycle management built for results. We manage front-end, mid-cycle, and back-end processes to increase clean claim rates, reduce A/R days, and support sustainable revenue growth.
