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NovaMed offers a comprehensive suite of Revenue Cycle Management (RCM) services, tailored to meet the operational and financial needs of today’s healthcare providers. From medical billing and coding to denial management, credentialing, A/R recovery, and payer communications—our services are built to maximize efficiency, compliance, and cash flow for practices of all sizes.
Explore the Full Cycle of Our RCM Services
From claim submission to denial appeals and financial reporting, NovaMed delivers a complete, transparent, and optimized revenue cycle experience. Each service is built to function as part of a cohesive system—designed for accuracy, speed, and compliance.
Click on any service to dive into the process, benefits, and what sets NovaMed apart.
Medical Billing & Claims Submission
Timely, Accurate, Compliant. Every Time.
At NovaMed Billing, our Medical Billing and Claims Submission service is the engine behind reliable revenue for healthcare providers. We ensure that every claim is submitted quickly, correctly, and with zero room for errors. From charge capture to payer submission, our team handles the full process to keep your revenue flowing.
Our certified billing experts stay ahead of payer requirements, compliance updates, and clearinghouse protocols—so your staff doesn’t have to.
Key Features of Our Billing Service
- Real-time Claim Submission
- Compliance with HIPAA & CMS
- Demographic & Insurance Scrubbing
- Clearinghouse Integration
- Claim Status Tracking
- Electronic & Paper Claim Handling
- Payer-Specific Rules Applied
- Batch & Real-Time Submission
- Multi-Specialty Support
- Daily Billing Activity Reports
Our Billing Workflow
We begin with complete and accurate charge capture—no missing codes, no lost revenue.
Our billing specialists extract data directly from patient encounters, EHR systems, and superbills. Every claim is then “scrubbed” for completeness, valid CPT/ICD/HCPCS codes, and payer-specific formatting.This step ensures:
All services provided are billed
No coding errors or mismatches
Compliance with CMS and commercial insurance policies
Accurate charge capture is where real revenue protection begins.
Once data is validated, we generate clean, compliant claims ready for immediate submission.
NovaMed supports both electronic and paper claim workflows, depending on the payer’s requirements. Claims are routed through our clearinghouse integrations, ensuring real-time validation and tracking.
This includes:
Batch or individual claim creation
Payer rules engine to avoid rejection triggers
Same-day claim transmission for eligible encounters
Real-time confirmation from clearinghouses and payers
The goal is simple: get your claim accepted the first time.
We actively monitor every payer response—and respond instantly to rejections.
Our team checks each ERA (Electronic Remittance Advice) and follows up on denials within 24 hours. Whether it’s missing information, authorization issues, or modifier errors, we identify and correct the problem quickly.
Included in this step:
Automated alerts for rejections and denials
Rapid reprocessing and resubmission of corrected claims
Ongoing analytics to reduce repeat errors
Clear documentation and audit trail for every adjustment
Fewer delays. More payments. No chaos.
Want Faster Reimbursements?
Let us handle your billing while you focus on care.
Specialty-Specific Medical Coding
Precision, compliance, and speed—built into every code.
NovaMed’s Medical Coding service is designed to eliminate claim errors at the root. Our certified coders ensure that every diagnosis, procedure, and service you perform is translated into clean, payer-ready codes using CPT, ICD-10, and HCPCS.
Whether you’re a single-specialty practice or a multi-specialty group, our team adapts to your documentation style, specialty nuances, and payer expectations to maximize accuracy and ensure faster approvals.
Key Features of Our Billing Service
- Certified CPT, ICD-10, HCPCS coders
- Specialty-specific coding rules
- Constant compliance with CMS, AMA, and payer guidelines
- Medical necessity validation
- Clinical documentation improvement (CDI) support
- Modifiers and bundling accuracy
- Daily error reports and pre-submission checks
- HIPAA-secure workflows
Our Coding Workflow: From Notes to Revenue
At NovaMed, your claims are coded by real, certified medical coders—not bots or low-cost offshore workers. We ensure that your documentation is translated into compliant, optimized billing codes using CPT, ICD-10, and HCPCS.
Every coder is trained to:
Follow payer-specific rules
Prevent upcoding and undercoding
Ensure correct diagnosis-to-procedure mapping
Track updates from CMS and AMA
Our process starts with a thorough review of clinical notes, followed by multi-layered code validation before submission.
We tailor coding to match the unique needs of each specialty. From modifier use in orthopedics to psych session bundling, we understand the quirks that matter.
Some specialties we code for:
Cardiology, Psychiatry, Orthopedics, Neurology
Pediatrics, Dermatology, Oncology
Surgical Subspecialties, Behavioral Health
OB/GYN, Pain Management, and more
By focusing on field-specific requirements, we reduce rejections and maximize approval rates.
Our coders don’t just stop at compliance—they go further to optimize claims for reimbursement and protect you from payer audits.
This includes:
Matching codes to supporting documentation
Assigning accurate modifiers (e.g. -25, -59, -LT/RT)
Running internal pre-bill audits
Providing feedback to your physicians for better charting
And if you want deeper visibility, we offer regular coding audits and reporting—to uncover missed revenue and spot patterns that could trigger denials.
Let’s Code It Right—From Day One
Accuracy in coding isn’t optional—it’s everything.
Contact NovaMed today to review your current coding workflow.
Insurance Eligibility and Benefits Verification
Reduce denials before they happen—with proactive, accurate pre-checks.
One of the leading causes of claim denials is incorrect or missing patient insurance information. NovaMed’s Insurance Eligibility and Benefits Verification service ensures that every patient’s insurance status, coverage level, and authorization requirements are confirmed before the visit ever occurs.
We work directly with payers to validate coverage, identify plan-specific limitations, and reduce surprise billing for patients and providers alike. By verifying eligibility upfront, we help your practice avoid costly rework and deliver a smoother billing experience for everyone involved.
Key Features of Our Billing Service
- Real-time insurance verification
- Coordination of benefits (primary vs. secondary payers)
- Deductible, co-pay, and out-of-pocket estimation
- Verification for all major commercial and government payers
- Pre-authorization requirement checks
- Daily eligibility reports sent to front-desk staff
- Denial prevention through payer-specific rule validation
- HIPAA-compliant processes and payer integrations
Our Verification Process: What Happens Before the Visit
NovaMed initiates eligibility checks as soon as an appointment is scheduled. Using integrated payer portals and clearinghouse connections, we verify insurance status, coverage details, and policy limits. All findings are delivered to your front office so they’re ready before the patient arrives.
This step includes validation of:
Active coverage status
Insurance type (HMO, PPO, Medicare, etc.)
Group number and plan details
Patient responsibility estimates
For services that require prior approval, NovaMed handles pre-authorization tracking and communication. We identify payer rules tied to visit types, procedures, or provider categories and flag any requirements in advance.
This includes:
Requesting authorization for procedures when needed
Tracking service limitations (e.g., therapy caps, visit counts)
Following up with payers for delayed or missing approvals
Communicating next steps with your practice staff
Our verification results are not just for your billing team—they’re designed to support your front-desk workflow. We provide daily eligibility summaries with actionable details for scheduling, patient check-in, and financial discussions.
This ensures that:
Your staff knows co-pay and deductible amounts in advance
Coverage gaps are addressed before service is rendered
Patients are informed, reducing billing confusion
Denials due to eligibility issues are virtually eliminated
Don’t Let Eligibility Errors Kill Your Claims
Discover how NovaMed helps practices reduce rework and increase collections—by verifying the right info at the right time.
Accounts Receivable Management
Accelerate your cash flow with active, strategic follow-up.
Unpaid claims are one of the biggest threats to financial stability in any medical practice. NovaMed’s Accounts Receivable (A/R) Management service is designed to aggressively follow up on outstanding balances, reduce aging receivables, and recover what you’ve earned—faster.
Our team handles the entire back-end process: identifying bottlenecks, tracking unpaid claims by payer, and initiating timely follow-ups. With real-time dashboards and a dedicated A/R team, we don’t just monitor receivables—we work them daily.
Key Features of Our Billing Service
- 30/60/90+ day receivables aging analysis
- Prioritized follow-up on high-value claims
- Daily A/R worklists and status updates
- Escalation of stalled claims to payers or supervisors
- Coordination with billing and denial teams
- Secondary payer billing and coordination of benefits
- Root cause analysis on delayed payments
- Transparent performance reporting and tracking
How NovaMed Manages Your Receivables—From Open to Paid
Each day, our A/R team generates updated aging reports categorized by payer, amount, and days outstanding. We identify claims at risk of write-off or denial and prioritize follow-up based on value, age, and payer-specific patterns.
This process includes:
Segmentation of accounts by age bucket (30, 60, 90, 120+ days)
Identification of trends (payer delays, coding errors, etc.)
Worklists built by claim type and priority
Coordination with billing team for resubmission if needed
Once claims are flagged, our staff initiates direct contact with payers—via portal, phone, or clearinghouse—to investigate status and resolve delays. We document every interaction and escalate when necessary.
What we handle:
Payer follow-up for status updates or missing information
Resubmission of corrected claims when errors are found
Appeals or disputes when claims are underpaid or denied
Real-time notes shared with billing and credentialing teams
When payments arrive, our system logs them into your preferred EHR or billing platform with full accuracy. We also provide weekly and monthly A/R performance reports, showing reductions in aging and total recovered value.
Key elements:
Timely payment posting and reconciliation
Credit balance resolution
Patient responsibility updates
Reporting on recovery rate, aging buckets, and payer performance
Stop Letting Revenue Slip Through the Crack
Let NovaMed take over your A/R management—and turn your backlog into cash.
Denial Management & Appeals
Recover lost revenue. Reduce rejections. Get paid what you deserve.
Claim denials aren’t just annoying—they’re expensive. At NovaMed, we take a systematic, aggressive, and intelligent approach to managing claim denials and filing appeals. Our team reviews each denial to identify the root cause, correct the issue, and resubmit the claim with supporting documentation that aligns with payer expectations.
We don’t just resubmit—we track trends, monitor denial rates, and implement proactive measures to prevent repeat errors. The result is higher recovery, fewer delays, and improved first-pass acceptance rates.
Key Features of Our Billing Service
- Identification of denial root causes
- Timely correction and claim resubmission claims
- Custom appeal letters and supporting documentation
- Real-time denial tracking and logging
- Appeal follow-up with commercial and government payers
- Insights on top denial reasons by payer
- Audit-proof documentation handling
- Denial rate reporting and prevention strategy
Our Denial Resolution Workflow
Every denied claim is flagged and routed to our denial team for investigation. We determine the exact reason for denial—whether it’s coding-related, eligibility-based, authorization-related, or due to documentation gaps.
This step includes:
Review of Explanation of Benefits (EOB) or remittance data
Categorization by denial type (technical vs. clinical)
Root cause tracking by provider, specialty, or payer
Collaboration with coding and eligibility teams
Once the issue is identified, we take swift corrective action. Depending on the cause, this could involve code correction, modifier addition, updated documentation, or eligibility clarification. Then we resubmit the corrected claim through the appropriate channel.
This process includes:
Preparation of clean, corrected claims
Updated attachments and clinical notes when required
Routing through clearinghouses or direct payer portals
Confirmation of resubmission acceptance
For claims that require formal appeals, we create custom appeal letters supported by coding logic, clinical documentation, and payer guidelines. At the same time, we document trends to implement long-term prevention strategies.
Key steps:
Appeal preparation with supporting evidence
Follow-up with payers to ensure timely review
Integration of denial insights into training and process updates
Reporting on denial frequency and resolution turnaround
Denied doesn’t mean done.
Partner with NovaMed to turn rejections into revenue—and prevent them from happening again.
Provider Credentialing & Recredentialing
Ensure compliance. Speed up payer enrollment. Start billing faster.
Credentialing delays mean delayed payments—and in many cases, no payments at all. NovaMed offers complete, end-to-end provider credentialing and recredentialing services for individual providers, group practices, and multi-specialty organizations.
We handle the full credentialing lifecycle: gathering documents, completing payer applications, following up with insurance networks, and maintaining recredentialing deadlines. Our service is designed to reduce administrative burden while ensuring you’re enrolled, verified, and billing-ready with every payer you work with.
Key Features of Our Billing Service
- Initial credentialing for new providers
- Medicare, Medicaid, and commercial payers
- CAQH registration and profile maintenance
- Application tracking and submission status updates
- Recredentialing and renewal reminders
- Licensing, DEA, NPI, and malpractice verification
- Payer follow-ups and issue resolution
- Digital document repository and audit trail
From Paperwork to Payer Approval: Our Credentialing Process
We begin by gathering all necessary provider information and verifying its accuracy. This includes licensure, board certifications, malpractice history, and practice affiliations. Then, we complete and submit applications based on each payer’s unique format and process.
Included in this step:
Collection of CVs, licenses, NPI, and W-9s
Review of previous credentialing data (if recredentialing)
CAQH profile creation or update
Completion of forms for Medicare, Medicaid, and commercial payers
After submission, we actively monitor the credentialing status with each payer. Our team follows up to resolve any issues, provide additional documents, and keep the process moving forward.
This stage includes:
Direct outreach to payers for status updates
Submission of missing or corrected documents
Communication with practice managers on pending items
Estimated go-live dates for billing start
Credentialing isn’t a one-time task—it’s ongoing. NovaMed tracks expiration dates and manages recredentialing across your entire provider roster to ensure continuous payer participation.
Our long-term process includes:
Automated recredentialing alerts
Monitoring of license, DEA, and certificate expirations
Payer updates when providers change addresses, affiliations, or specialties
Full documentation archive for audits or internal review
Credentialed. Verified. Billable.
Let NovaMed take over the credentialing hassle—so you can focus on care, not paperwork.
Patient Billing and Statement Services
Transparent, professional communication that builds patient trust—and drives collections..
Patient billing is one of the most sensitive and often neglected parts of revenue cycle management. NovaMed provides a dedicated patient billing and statement service that ensures patients receive clear, timely, and accurate billing communications. We aim to reduce confusion, minimize disputes, and increase collections—while maintaining a professional and respectful tone throughout.
Our services are fully HIPAA-compliant and designed to integrate seamlessly with your current practice systems. Whether it’s sending out statements, managing balance follow-ups, or responding to billing inquiries, we make the process easy for both providers and patients.
Key Features of Our Billing Service
- Branded, easy-to-read patient statements
- Customizable messaging for specific services or balances
- Multiple delivery methods (paper and digital)
- Integration with your EHR or billing platform status updates
- Friendly, professional balance follow-up
- Support for patient billing questions and disputes
- Payment posting and reconciliation
- HIPAA-secure handling of all patient financial data
How We Handle Patient Billing—From Statement to Settlement
NovaMed manages the full process of generating and delivering patient statements. We use up-to-date account data from your billing platform to create accurate, detailed invoices that clearly outline charges, payments, and outstanding balances.
This step includes:
Statement formatting based on your brand and preferences
Batch or on-demand statement creation
Delivery via paper mail or secure digital portal
Clear presentation of insurance adjustments and patient responsibility
After statements are sent, our team handles friendly balance follow-ups, ensuring patients understand their bills and have support in resolving them. We respond to inquiries, explain EOBs, and manage disputes if they arise.
This includes:
Outbound balance reminders via phone or mail
Real-time access to billing information for support teams
Patient education on billing terminology and charges
Guidance on insurance questions and co-pay structures
When payments are received, NovaMed posts them to the correct accounts and reconciles balances. Our system ensures accurate allocation, resolves overpayments, and flags accounts for collections if needed.
We also provide regular reporting on:
Patient collections rate
Open balances by aging bucket
Payment trends by location or service type
Flagged accounts needing provider input
Clear billing builds trust—and collects more.
NovaMed helps you communicate effectively with patients while accelerating payments.
Revenue Analytics and Financial Reporting
Clear insights. Smarter decisions. Stronger financial performance.
In medical billing, data isn’t just numbers—it’s your practice’s financial health. NovaMed provides customized revenue analytics and performance reporting to help providers track KPIs, uncover inefficiencies, and make informed operational decisions.
Our reporting tools turn raw data into actionable insights, with visual dashboards and detailed breakdowns that highlight trends in billing, denials, reimbursements, and cash flow. Whether you’re a solo provider or managing multiple locations, we help you see what’s working—and what’s costing you money.
Key Features of Our Billing Service
- Custom revenue cycle reports
- Weekly, monthly, and quarterly summaries
- Performance metrics by provider, payer, or location
- Claim acceptance and denial rate tracking
- Aging A/R breakdowns and collection ratios
- Payer-specific reimbursement analysis
- Financial forecasting support
- HIPAA-compliant data storage and reporting delivery
From Data to Strategy: How NovaMed Powers Smarter Billing
NovaMed offers customized reporting tailored to the structure and goals of your practice. Whether you’re focused on collections, denial rates, or payer trends, we deliver reports that align with what you need to know—not just generic spreadsheets.
This includes:
Provider and department-level financial summaries
Claim volume, success rate, and turnaround time metrics
Top 10 denial reasons and impact by payer
Net collections vs. gross charges tracking
Our analytics platform surfaces trends and opportunities—so you don’t just see the numbers, you understand what they mean. We help you identify underperforming services, problematic payers, and workflow bottlenecks that affect revenue.
Deliverables include:
Interactive dashboards with filterable metrics
Year-over-year and month-to-month comparisons
Denial cause analysis and improvement recommendations
Payer performance benchmarking
Reporting is only useful when it leads to action. Our team interprets results and advises on operational and financial improvements, helping your team adjust workflows, improve documentation, or refine payer communication.
Services include:
Scheduled reporting reviews with RCM consultants
Identification of revenue leakage points
Compliance alerts tied to documentation and coding
Data to support staffing and resource decisions
Your billing data should work for you—not overwhelm you.
Let NovaMed turn your numbers into strategy.
Practice Management Consulting
Optimize your operations. Improve compliance. Drive sustainable growth.
Running a medical practice today requires more than good clinical care—it demands efficient operations, regulatory compliance, and smart financial planning. NovaMed’s Practice Management Consulting service helps providers analyze, improve, and strengthen their internal workflows, so they can focus on patient care while optimizing performance.
From front-desk operations to claims lifecycle tracking, we assess the full revenue cycle and offer targeted guidance to streamline billing processes, reduce waste, and improve profitability.
Key Features of Our Billing Service
- Front-office workflow evaluation
- Billing process optimization
- Compliance reviews and documentation audits
- Scheduling and patient flow assessment
- Staff training and best practice development
- Denial trend analysis and process redesign
- Financial health checkups and growth strategies
- Integration of technology with billing operations
How NovaMed Helps Practices Run Better
Our consulting begins with a full review of your current systems, staff responsibilities, and billing operations. We create a clear process map that identifies gaps, redundancies, and missed revenue opportunities.
This phase includes:
Observation of scheduling, check-in, coding, and billing flow
Interviews with staff and billing team
Analysis of EHR/billing platform setup and usage
Identification of delays and breakdown points
We help you align your workflows with CMS and HIPAA compliance standards while improving efficiency. Whether it’s improving encounter documentation or refining eligibility checks, we guide you through best practices that reduce denials and improve throughput.
Key actions include:
Coding and documentation audits
Front-end denial prevention training
Process redesign for pre-authorizations, follow-ups, and A/R
Compliance and billing policy checklists
Beyond fixing what’s broken, we offer forward-looking advice to help you scale. We help practices implement performance tracking, set financial benchmarks, and train staff for long-term success.
This includes:
Recommendations for KPIs and reporting practices
Templates and SOPs for daily operations
Staff role definition and task alignment
Growth strategy planning tied to financial goals
Better systems mean better care—and better collections.
Let NovaMed help you turn operational challenges into growth opportunities.