Module 3: RCM Discovery

Section in wizard: RCM IQA Time to complete training: 14 minutes Time per discovery: 6–9 minutes

Why this section matters

Revenue Cycle Management is the largest recurring revenue line in our portfolio and the stickiest service we offer. Once a practice is on our RCM at 7% of collections, switching is painful — they'd have to migrate clearinghouse credentials, retrain staff, rebuild reporting, and absorb 30–60 days of disruption. That's why RCM customers stay 4+ years on average and why every credentialing-only deal should be examined for an RCM upsell.

It's also the section where the math gets specific. A practice doing $1.5M annual collections is a $105K/year RCM customer. That single line item in the proposal funds the relationship. Every other service we sell into that account is incremental margin.

But RCM is harder to sell than credentialing because the prospect is rarely as panicked. Their billing might be mediocre, but mediocre is functional. Your job in this section is to make mediocre feel expensive.

What we're really learning

What does their billing actually cost them? Not the percentage they pay a biller — the all-in cost including staff time, denials, write-offs, and aging A/R. Most prospects only count the visible cost. The invisible costs are usually 2–4x larger.
Where is revenue leaking? Denials, slow filings, missed charges, undercoding, write-offs they shouldn't be writing off, contractual adjustments they should be appealing. Find one specific leak. Make it concrete.
What's their relationship with their current billing setup? In-house biller they love but who's a single point of failure? Outsourced biller who's unresponsive? EMR-bundled billing that came with the platform? Each requires a different conversation.
Who owns the financial outcome? In a small practice it's the owner. In a larger practice it might be a practice manager, a CFO, or an external CPA. RCM decisions usually require multiple stakeholders. Find them now.

Listening cues

Strong buying signals:

A specific number for denials, A/R aging, or first-pass clean claim rate that's worse than benchmark.
"Our biller doesn't really work appeals."
"We don't have great visibility into what's getting paid versus what's still outstanding."
They've fired or are about to fire their current biller.
Recent staff turnover in the billing seat.
An EMR-bundled billing service that's caused frustration ("we got it because it came with the platform but it's not working out").

Lukewarm signals:

"Billing is fine, I think."
They can't tell you their A/R aging or first-pass rate at all.
They have a long-tenured in-house biller they're loyal to.
They've been with the same outsourced billing company for 10+ years and have nothing bad to say.

Cold / disqualify signals:

Monthly collections under $30,000 — the 7% economics don't work for either side.
They want to "outsource billing for cheap" — we are not cheap and shouldn't pretend to be.
They want a hybrid where they still do half the work themselves and pay us a reduced rate. Decline politely.

Red flags / disqualify guidance

De-prioritize when:

Sub-$30K monthly collections. At a 7% rate with our $350 minimum, the per-claim economics break down for both sides. Refer them to a self-serve billing platform or pause until they grow.
They want a hybrid model. "We'll do the easy claims, you do the hard ones" is operationally a nightmare and never has clean accountability when revenue dips. We do end-to-end RCM or we don't engage.
The prospect is hiding something. If they refuse to share collections numbers, won't grant read access for an A/R audit, or get evasive when you ask about denial rates, there's usually a reason. Sometimes it's a compliance issue, sometimes it's that they're 90+ days behind and embarrassed. Either way, the deal isn't ready.
Single-provider practice with low complexity payer mix. Cash-only practices, concierge-only practices, and practices with 1–2 payers are usually better off in-house. Don't force a fit.
Active payer audit or recoupment in process. Don't take over RCM mid-audit. Wait for it to resolve, then re-engage. Taking on a book mid-audit means inheriting the problem.

Common rep mistakes

Leading with our percentage rate. "We charge 7%" is the wrong opening. The right opening is "what's your billing actually costing you all-in?" Rate becomes the punchline, not the headline.
Not asking about first-pass clean claim rate. This single metric tells you more than any other. Industry average is 90–93%. Strong is 96%+. If a prospect says they don't know, that's a finding in itself — they don't have visibility into their billing performance.
Accepting "we have a great biller" at face value. A great biller can become a single point of failure overnight. The right follow-up is "if she got hit by a bus tomorrow, what would happen?" Make the risk visible.
Skipping the EMR question. What system they bill from determines a lot of our implementation cost and our willingness to engage. Some platforms are easy (Athenahealth, Tebra, AdvancedMD). Some are painful (Practice Fusion's billing module, certain EMR-bundled platforms). Get this on the record.
Quoting before you have collections numbers. Without monthly collections, you can't price RCM. If the prospect won't share numbers, that's a qualifying issue, not a "we'll work around it" issue.
Forgetting to surface the upside. RCM customers don't just save money — they make more. A practice with a 12% denial rate that drops to 5% under our management recovers 7 points of revenue. On $1.5M, that's $105K. The 7% fee literally pays for itself before they cut the first check.

Sample dialogue

Opening the section

Rep: "Tell me about your current billing setup. Is billing in-house, outsourced, bundled with your EMR — what does it look like today?"

Prospect: "We have an in-house biller, Maria. She's been with us six years."

Rep: "Got it. Does Maria handle everything end-to-end — charge entry, claims submission, denials, appeals, posting payments, A/R follow-up?"

Prospect: "Pretty much. We have her plus a part-timer who helps with payment posting."

You're starting to map the workflow. The next question separates "comfortable with current setup" from "actually performing well."

Probing on performance

Rep: "What's your first-pass clean claim rate looking like? And how would you describe your A/R over 90?"

Prospect: "Honestly, I don't know off the top of my head. Maria runs the billing reports."

Rep: "That's pretty common, actually — most owners I talk to don't know their numbers because there's no one giving them a dashboard. Industry average for clean claim rate is around 91%. We aim for 96%+ for our clients. Every percentage point under that is roughly 1% of revenue you're not collecting on the first try, and a lot of it never gets collected at all. On a practice your size, the difference between 91% and 96% is meaningful — easily $50–$75K a year."

You've made the invisible visible. You've also positioned us as the people with the dashboard.

Surfacing risk and opportunity

Rep: "When Maria takes vacation or gets sick, what happens to the billing?"

Prospect: "Honestly it kind of stops. We try to keep up, but it backs up."

Rep: "That's a real risk. Most practices we take over from in-house billing weren't unhappy with the biller — they just realized they had a single point of failure that was costing them money invisibly. With us, you have a team of 10+ billers covering your account, denial specialists, payer contract experts, and reporting that gives you weekly visibility. The fee is 7% of collections with a $350 minimum, and the implementation is a $350 one-time. Most practices we onboard see their net collections go up enough in the first 90 days to cover the fee outright."

You've named the risk, named the model, named the price, and made the ROI explicit.

Specific to startups

For a new practice:

Rep: "Since you're launching, this is actually the easiest version of this conversation. Setting up RCM from day one means we configure your clearinghouse, payer enrollment for billing, denial workflows, and reporting before your first claim ever goes out. Practices that try to set this up after launch always end up with backlogs and missed revenue in the first 60 days. We can have you ready to bill clean on day one."

Transition out

Rep: "Okay, I'm going to shift to your website and online presence next. The reason I ask is that for a practice with a $1.5M run rate, you're typically getting 60–80% of new patients through online discovery, and if that funnel isn't working you'll feel it before any of the billing or credentialing work pays off."

Bridge to the next section while reminding them everything connects.

Wizard fields covered in this section

billingModel, billingType, billingIssues, arRange, billingConfidence, monthlyCollections, ehrBillingPartner

What good looks like

A completed RCM IQA where:

Monthly collections is a real number, not a guess
At least one specific performance metric is captured (denial rate, A/R aging, clean claim rate) — even if the answer is "I don't know," that's a captured data point
The current billing model is specifically named, not just categorized
The notes field captures whether there's a switching trigger (biller leaving, EMR change, dissatisfaction) or whether this is a cold prospect that needs to be warmed
The EHR/billing partner is identified, because that determines our implementation effort