The Medical billing & RCM
Your billers spend half the dayon work a payer portal could do.
Medical billing companies run on people retyping information between PM systems, clearinghouses, and a dozen payer portals. We put an engineer inside your operation, watch how the work actually moves, and automate the parts that repeat, until at least 20 hours a month per team are back.
The systems your team already uses, wired through Passel automations. Your people review exceptions instead of retyping.
of claims denied on first submission
Industry surveys · typical range
to rework a single denied claim
Practice-level estimate · more for facilities
of denials never get reworked
Commonly cited industry estimate
a month back, per team, or we keep working
Our written commitment
Independent billing services, RCM companies, and practice-management firms with 5 to 200 billers, working across multiple clients, specialties, and payer mixes. Especially if your team lives in Availity, Waystar, or a stack of payer portals.
Figures are typical ranges from published industry surveys and our own audits. Your Gap Report replaces them with your numbers.
Why the hours go missing
The systems don't talk. So your people do the talking.
A billing company's stack was never designed as one system. The PM software holds the patient. The clearinghouse holds the claim. Each payer holds the truth about what happened to it, behind its own portal with its own login. Nothing moves between them unless a person moves it.
So the most experienced people on your floor spend their mornings checking claim status one at a time, their afternoons posting remits line by line, and their month-end rebuilding the same client report in Excel. None of that is billing. It's transport.
We automate the transport. Status pulls, eligibility batches, posting, denial sorting, and reporting run on a schedule. Your billers work the exceptions, the appeals, and the client relationships, which is the part that needs a biller.
The workflow map
13 things your team does by hand that it shouldn't have to.
Grouped by where they sit in your operation. Each card shows what happens today, what we build, and the time it typically gives back per person.
Before the claim
Front end
Eligibility & benefits verification
2–6 h/wkTodayStaff log into Availity or payer portals one patient at a time and retype coverage details into the PM system.
What we buildNightly batch verification on tomorrow's schedule. Exceptions land in a worklist with the payer response attached.
Prior authorization tracking
2–4 h/wkTodayAuth numbers live in spreadsheets, faxes, and portal inboxes. Expirations are discovered when a claim denies.
What we buildAuth status pulled from portals into one tracker. Expiring auths flagged ten days out with the renewal pre-filled.
Demographics & insurance entry
1–3 h/wkTodayIntake sheets and card images keyed by hand. Typos surface as rejections weeks later.
What we buildCard and form capture validated against payer rules before the record is saved.
Building the claim
Mid cycle
Charge entry & reconciliation
2–5 h/wkTodaySuperbills or EHR encounters compared to posted charges, line by line, to find what's missing.
What we buildAutomated reconciliation between encounters and charges. The gaps are listed each morning, not found at month end.
Claim scrubbing & rejections
2–4 h/wkTodayClearinghouse rejections worked from an inbox. The same edits fixed over and over.
What we buildRejection reasons mapped to fixes. Recurring ones corrected before submission; the rest routed with the fix suggested.
Coding review queue
1–3 h/wkTodayCoders wait on documentation queries and re-open charts to check modifiers and payer policy.
What we buildChart, code set, and payer policy pulled together for review. Provider queries drafted automatically.
After submission
Back end
Claim status checks
4–8 h/wkTodayThree to twelve payer portals, one claim at a time, screenshots pasted into account notes.
What we buildStatus pulled for every open claim on a schedule and written back to the PM system. Only claims that need a call reach a person.
Denial management & appeals
4–8 h/wkTodayDenials sorted by hand. Appeal letters rewritten from scratch. Timely-filing deadlines tracked in memory.
What we buildDenials categorized by CARC/RARC. First-draft appeals generated with the chart and policy attached. Deadlines on a calendar.
Payment posting & ERA reconciliation
3–6 h/wkTodayERAs and paper EOBs posted line by line. Unapplied cash chased at month end.
What we buildAutomated ERA posting with variance detection. Only mismatches, takebacks, and underpayments reach a person.
AR follow-up prioritization
2–4 h/wkTodayAged AR reports worked top to bottom, regardless of value, payer, or likelihood of payment.
What we buildA worklist ranked by dollars, age, payer behaviour, and filing deadline, refreshed daily.
Patient statements & balances
1–3 h/wkTodayStatement runs, address corrections, and payment-plan follow-ups handled by hand.
What we buildStatement cycles, reminders, and plan tracking on a schedule, with exceptions surfaced.
For your clients
Client & reporting
Client month-end reporting
2–4 h/wkTodayReports exported from the PM system and reassembled in Excel for every client, every month.
What we buildClient reports generated in your template on schedule, with commentary drafted for a manager to review.
Client requests & onboarding
1–3 h/wkTodayQuestions arrive by email and get answered by pulling reports by hand. New clients set up from a checklist.
What we buildA request inbox that pulls the answer from the PM system. Onboarding checklists that create the setup work automatically.
Hours are per person, per week, typical range. Most operations run several of these at once, which is how an audit finds 20 hours a month across a team without anyone working differently.
Inside your stack
Built into the tools you already pay for.
We don't replace your PM system or clearinghouse. We connect them, using their APIs where they exist and careful browser automation where they don't, so your billers stop being the integration layer.
No new software to learn
Automations live inside the systems your team already opens every morning. If someone has to open a new app to feel the difference, we built it wrong.
HIPAA, verified before anything moves
Our HIPAA compliance program is independently verified through Live Compliance. We sign a Business Associate Agreement before any PHI is in scope, work under minimum-necessary access, and de-identify wherever the work allows.
A person stays in the loop where it matters
Anything that touches money, a patient, or a client gets a human checkpoint by design. Automation does the retyping. Your people do the judgement.
Common questions
What billing companies ask us first.
Can you automate payer portals that have no API? +
Usually, yes. Most of the portals billers live in have no API, so we build careful browser automation that logs in with your credentials, pulls what a person would pull, and writes it back to the PM system. It runs on a schedule, handles the login and layout quirks, and alerts a person when a portal changes. Where a payer offers a real-time eligibility or claim-status connection, we use that instead.
Will this work with our PM system? +
Almost certainly. We've mapped the common ones (Kareo/Tebra, AdvancedMD, athenahealth, eClinicalWorks, NextGen, Office Ally, CollaborateMD) and we work with whatever you run. The Observer phase is where we confirm exactly how your team uses it, because two billing companies on the same software rarely use it the same way.
How do you handle PHI during the audit? +
A Business Associate Agreement is signed before the Observer is deployed. The agent captures application-level activity signals, which systems are in use and how long each recurring cycle takes, aggregated at the team level and encrypted in transit and at rest. The telemetry scope, what it captures and what it never touches, is defined with you in writing before it reaches a single workstation. Our HIPAA program is independently verified through Live Compliance.
What does 20 hours a month actually mean for a billing team? +
Twenty hours of staff time per month, measured against what the Observer found, that your team no longer spends on the automated work. For a team of eight billers, that's typically one or two workflows from the map above. Most billing companies have far more than that available; twenty is the floor we commit to in writing, not the ceiling.
Next step
Find out what your billers could stop doing by hand.
One call, then two weeks with the Observer on every desk. We don't stop until at least 20 hours a month are back.
info@thepasselgroup.com