Quality Payment Program (Merit-based Incentive Payment System – MIPS) is a healthcare quality improvement incentive program initiated by CMS. At MedRCM, we aggregate, analyze, and electronically submit qualifying data to CMS thus avoiding penalties and gaining incentives on the physician practices.

MedRCM’sMeaningful Use” (MU) reporting provides the necessary data points and knowledge needed to assist our clients to intelligently manage their day-to-day operations, efficiently manage their communication protocols and more importantly to achieve consistent / predictable collection numbers. Our solutions ensure a comprehensive and relevant summary of key metrics designed to improve administrative, operational and financial performance. Its capabilities enhance the insight across the organization – from insurance calling agents to the executives – to more effectively manage their collection trends, determine actionable insights and analyze data in a more meaningful way. We believe our dashboards will assist the end users to manage their respective functional areas of the business more effectively.

MedRCM team has expertise in

Medicare quality payment program of “The Merit-based Incentive Payment System (MIPS)”

Medicaid program of “Meaningful Use (MU)”

Our training team will

Educate the staff and providers regarding the programs and tips to achieve maximum score/reimbursement.

Monitor the score and suggest modifications to the workflow to increase the score

Design workflows to manage their day-to-day operations efficiently while ensuring the data is entered/collected for the quality payment programs.

Guide the providers in data submission to CMS

Revenue cycle management

MedRCM puts latest technology to work ensuring high performance standards with breach-proof security.

Get the full payment that you’ve earned with revenue cycle management solutions from MedRCM. Our comprehensive revenue cycle technologies cover the complete range of revenue cycle management (RCM), while the MedRCM medical billing and coding team with certified coders allows your staff to focus on patients.

With MedRCM your practice will benefit from:

Faster collections and improved cash flow

Cost savings by implementing best practices

Identification of revenue opportunities

Full compliance with HIPAA and state regulations

MedRCM gives you the ability to track the claims process throughout its life cycle to facilitate a steady revenue stream. We also address denied claims that can cause up to 90% of missed revenue opportunities.

MedRCM Services and Capabilities:

Credentialing: Dedicated experts for credentialing and contracting to get our Providers enrolled with the best rates and plans.
Coding: Accurate coding to maximize revenue and decrease compliance-related risks.
A/R Follow-up: Constant communication with payers on accounts receivable using phone, email and web.
Patient Collections: Answers inbound patient calls related to self-payment responsibilities.
Payer Eligibility & Verification Services: Insurance verification, Benefits management and patient eligibility automation.
Complex Claims: Manage the paper work and follow-up associated with your workers’ compensation, no-fault, and MVA claims.
Denial Management: Identifies unpaid claims or underpayments by payers at the individual claim level.
Platform Agnostic: Ability to work with multiple platforms.
Charge Capture and Billing: Timely charge entry and submittal
of error-free claims and
cash posting.
Denial Prevention: Validation of superbills and/or electronic claim scrubbing to prevent clearing house/payor denials/rejections.
Coding Audits and Provider Education: Recommendations for overlooked billing opportunities.


We understand the importance of provider training and adoption during new EHR implementation or conversion. Our One-On-One Provider EMR training is focused specifically on provider clinical workflows and typically takes about half the time of our Instructor-Led End-User Training.

Our EMR Training curriculum is customized to each client, with individual workflows defining a personalized approach. We have a unique approach, catering to individual user groups, ensuring a better learning experience. Our training experts can staff or supplement all of your training needs.


Keeping Physicians Compliant

The healthcare landscape is constantly evolving with new rules and regulations that are fundamentally changing the way physicians work and practice. The world of coding is just one of these frequent changes that occur on a regular basis. From ICD-9 to ICD-10 to RAC Audits to new modifiers, it is a challenge to keep pace with the new rules and coding practices.

MedRCM has a team of certified coders that help physicians in 50+ specialties to not only code correctly but also look for opportunities where physicians may be under-coding. We can provide both proactive and retroactive coding audits to ensure that practices remain compliant with coding guidelines. In the daily life of a practice, it’s easy to repeat broken processes or mistype information due to the fast-pace environment.

CMS recommends that providers seek external reviews to help ensure that practices remain compliant in order to avoid potential fines and hours of time with paperwork. MedRCM’s team has kept many practices compliant, saving them hundreds of thousands of dollars in fines. In addition, we’ve helped prepare organizations with proper self-reporting when experiencing an OIG audit.

What MedRCM Delivers

Proactive claim and document reviews identify coding and modifier errors

Comprehensive analysis of your contracts, claims, and payments to find potential underpayments

Expert coders help you avoid legal and financial exposure

Allows your staff to focus on patients while receiving additional training and education from our experts

Unbiased reviews prepare you for OIG and RAC audits

Reduce Compliance Risk

Achieve coding accuracy at the highest level to help prevent missed revenue opportunities.

Optimize front-end and back-end billing processes to help streamline operations and improve overall billing integrity.

Meet compliance obligations and receive recommendations to help you achieve desired coding outcomes.

Ensure appropriate billing for documented procedures to help mitigate risk.

Identify under or overbilling of services from comprehensive reviews and charge capture audits.

Uncover trends and identify opportunities for improvement to achieve financial and data-quality goals.


How healthcare is delivered, managed, and paid for is constantly evolving.

Changes are driven by both government regulations and increased competition and financial pressure.

To be competitive in your market, your business needs to understand the drivers of performance, the impact of quality on financial outcomes, and the impact of potential efficiency gains.


Building a data-driven organization takes more than technology. We are experts in the data and analytics needed for today’s healthcare environment. We have a proven track record of helping clients develop progressive, innovative capabilities for long-term success.

We unlock the power of your data for a more comprehensive view of your patient, population, network, revenue cycle, and organizational health.

We help you connect and transform various data points into actionable insights and help you benchmark with your peers so you can make more informed decisions across your organization.

Provide usable, on-demand data across care settings

Intelligent use of your strategic data resources is critical in today’s environment. These are just a few reasons why:

The volume of healthcare data is growing by 48% each year.

Value-based reimbursement contracts will soon make up the majority of payments.

Federal requirements demand increasingly sophisticated health data exchange and interoperability.

Providers seeking to improve care quality, to manage population health, and to thrive in the transition to value-based care must increase their data competency.

Make wise decisions with financial analytics

Healthcare stakeholders need to predict, model, and measure best practices and optimal outcomes to facilitate better strategic and operational decisions across your organization.

Cost accounting, revenue modeling, and quality analysis correlate outcomes with profitability, helping you identify high-yield opportunities for performance improvement.

Use clinical and financial intelligence to assess risk

For providers, new payment models under value-based care reward participation in their patients’ upside and downside risks. Gain the clinical insights and business intelligence to help you answer these questions, engage your provider network, and meet quality-of-care and financial goals.

Drive your revenue cycle with data

Revenue cycle analytics use a wide range of data sources to help you make smart decisions in billing efficiencies, reimbursements, payer relations, charge monitoring, and clinical services.

We deliver timely, equitable data to help you establish benchmarks, compare performance, and justify decisions.

Interact with data discovery tools

Your data can do more than report on the past. Your healthcare data is full of insights, with the information you need to succeed in a changing healthcare landscape.

Use our interactive data visualization and discovery tools to connect large, complex, multi-structured data sets.

We help you use the data you already have to predict and discover trends and hidden patterns. Interactive business intelligence can drive performance improvement throughout your business.


MedRCM’s Care Management Services are for providers that want to improve quality of patient care and engagement while getting reimbursed through payer value-based programs.

Advantage with MedRCM

Improve patient self-management to help increase efficiencies.

Improve the patient experience and patient satisfaction by coordinating care between providers and providing patient outreach.

Optimize new reimbursement streams to help improve your bottom line.

Improve quality outcomes by providing additional care services to your chronically ill patients.

Accelerate meeting payment requirements to qualify for the Merit-based Incentive Payment System (MIPS).

Put your physicians on the road to value-based care and succeed in new reimbursement programs.

Chronic Care Management

Chronic Care Management Services provide comprehensive care coordination that helps advance the support of your chronically ill Medicare patients and puts your providers on the road to a value-based future.

Get help developing a chronic care management program designed to support improved patient outcomes and to drive recurring reimbursement revenue without increasing staff or adding significant costs.

Meet CMS’ billing requirements for chronic care management, complex chronic care management, and the Merit-based Incentive Payment System (MIPS) with non-face-to-face services that provide nurse care plans, comprehensive assessments and medication reconciliation.

Extend your provider office with nursing and other clinical support staff who connect with your patients on a monthly basis to improve patient engagement and quality of care.

Transitional Care Management

Support patients between care settings with our Transitional Care Management Services. With 24/7 access to electronic care plans, our staff can help coordinate patient care between providers, helping to improve outcomes and increase reimbursement.

Reduce the risk of readmission with Transitional Care Management Services. Improve outcomes by contacting patients within two days of discharge, and providing follow-up care coordination within 30-days.