Enterprise Hospital Billing and Revenue Cycle Management
Overview
Hospital billing is among the most complex revenue cycle management disciplines in healthcare, requiring mastery of UB-04 claim forms, DRG coding, case mix optimization, charge description master management, and the unique compliance requirements of inpatient and outpatient hospital billing.
Rafsons Med Billing hospital billing division brings enterprise-grade RCM expertise to health systems, acute care hospitals, critical access hospitals, and specialty hospitals of all sizes. Our hospital billing specialists are certified in facility fee coding, DRG assignment, MS-DRG optimization, and hospital outpatient coding using APC methodology.
We integrate directly with hospital information systems and enterprise EHR platforms to deliver seamless billing operations, robust revenue reporting, and proactive denial management across all hospital revenue streams.
Key Benefits & Outcomes
UB-04 and CMS-1500 Billing
Expert facility and professional fee billing across all hospital revenue centers and service lines.
DRG and Case Mix Optimization
Clinical documentation improvement and DRG optimization programs that maximize inpatient reimbursement.
CDM Management
Comprehensive charge description master review, maintenance, and optimization to ensure accurate charge capture.
Outpatient APC Billing
Specialized hospital outpatient billing with APC grouping optimization and comprehensive OPPS compliance.
Medicare Cost Report
Expert Medicare cost report preparation and reconciliation for critical access and qualifying hospitals.
Revenue Integrity Programs
Comprehensive charge capture audits, clinical documentation improvement, and revenue integrity monitoring.
Our Process
System Integration
We integrate with your HIS and EHR system for automated charge data and clinical documentation access.
Charge Review and Coding
Facility charges are reviewed, coded with appropriate ICD-10-PCS and DRG or APC codes, and scrubbed.
UB-04 Claim Generation
Complete UB-04 claims are generated with all required data elements and payer-specific requirements.
Payer Submission
Claims are submitted electronically to all payer types including Medicare, Medicaid, and commercial.
AR and Denial Management
Comprehensive AR follow-up and denial management ensures maximum collection across all payer types.
Frequently Asked Questions
What size hospitals do you work with?+
Do you handle both inpatient and outpatient hospital billing?+
Can you integrate with our hospital information system?+
What is clinical documentation improvement?+
Transform Your Hospital Revenue Cycle
Enterprise hospital billing expertise that maximizes reimbursement across every service line.