Full-cycle hospital & facility billing: what it covers

The full-cycle workflow

Front end

Eligibility verification and authorization for inpatient admission or outpatient procedures.
Pre-registration and bed-day or level-of-care certification where required.
Patient data entry, checked against the facility's admission records.

Middle

Charge capture reconciled across departments (lab, imaging, OR, pharmacy) into one claim.
Revenue code and HCPCS/CPT assignment, with DRG or APC grouping as applicable.
UB-04 claims submission and payment posting against per-diem or case rates.

Back end

Denial management for medical-necessity, level-of-care, and length-of-stay denials.
Appeals filed with clinical documentation and utilization-review support.
Patient billing for facility fees and coinsurance.

Oversight

Department-by-department charge reconciliation tracking.
A/R aging and denial-rate reporting by payer and service line.

Where practices get stuck without it

Charges from different departments don't reconcile into one clean claim before the billing deadline.
Length-of-stay denials go unappealed because utilization review and billing aren't coordinated.
Revenue code errors cause claim rejections that take days to trace back to the source.
There's no consolidated view of facility-wide accounts receivable across service lines.
Patient billing for facility balances gets delayed behind the claim reconciliation process.

What a RCVRY full-cycle billing team handles

Charge Reconciliation

Pulls every department's charges together before the claim goes out.

Verifies eligibility and authorization before admission.
Confirms bed-day or level-of-care certification.
Reconciles charges from every contributing department.

UB-04 Coding & Claims

Catches charge-capture gaps before they turn into rejections.

Assigns revenue codes, HCPCS/CPT, and DRG or APC grouping.
Submits clean institutional claims on the correct form.
Flags missing department charges before submission.

Denials, Appeals & Reporting

Works length-of-stay and medical-necessity denials with the same urgency as professional claims.

Appeals with clinical and utilization-review documentation.
Handles patient billing for facility balances.
Reports A/R and denial rate by payer and service line.

Who this process is for

Hospitals and ambulatory surgery centers whose billing office is stretched across departmental charge capture, and facilities that need length-of-stay and level-of-care denials worked promptly instead of stacking up in a queue.

Full-cycle hospital and facility billing: what it covers