Revenue Cycle Workflow

Seven intelligent, interconnected workflow stages - each powered by AI - delivering end-to-end automation from the first patient encounter to final cash collection.

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7

Workflow Stages

95%

First-Pass Resolution

40%

Denial Rate Reduction

5x

Coder Productivity Gain

The 7-Stage Emed PRO Workflow

A seamlessly connected revenue cycle - from onboarding through collections - driven by AI at every stage.

1

Demo & Onboarding

Experience the full platform before committing. Our structured demo process walks you through every workflow stage using your organization's own profile - followed by a rapid, guided onboarding designed to get your team live within 4 weeks.

Personalized Demo

Live walkthrough tailored to your specialty and payer mix

4-Week Go-Live

Structured implementation plan with dedicated success manager

Training Included

Role-based training for coders, billers, and administrators

Data Migration

Historical data migration support for uninterrupted continuity

2

AI-Assisted Coding

NLP-powered code suggestion engine reads clinical documentation and extracts ICD-10-CM, HCC, and CPT codes with 95% accuracy - presenting ranked suggestions with supporting clinical evidence so coders can review, not re-read the entire note.

Contextual Code Extraction

Extracts from progress notes, discharge summaries, and op reports

Evidence Citation

Every suggested code linked to the supporting clinical sentence

Confidence Scoring

AI confidence % shown per code - coders prioritize review effectively

Multi-Code Logic

Principal diagnosis sequencing and MCC/CC capture automated

3

Charge Entry

Automated charge capture from validated codes directly into your practice management or billing system - with built-in edits preventing invalid code combinations, missing modifiers, and unbundling errors before the claim is ever submitted.

Auto-Charge Capture

Charges built automatically from finalized code set - zero rekeying

Edit Rules Engine

CCI, LCD, and NCD edits applied pre-submission for clean claims

Modifier Logic

Correct modifier application (25, 59, 76 etc.) automated by payer

Fee Schedule Mapping

Expected reimbursement calculated per charge line at entry

4

Payment Posting

Electronic remittance (ERA/835) auto-posted with intelligent matching - reducing manual payment posting effort by 90% while identifying underpayments, contractual variances, and balance bill opportunities in real time.

ERA Auto-Posting

835 remittance files matched and posted automatically per claim

Underpayment Detection

Variance between contract rate and actual payment flagged instantly

EOB Parsing

Paper EOBs scanned and data extracted via Emed OCR integration

Patient Balance Logic

Patient responsibility calculated and statements generated post-post

5

AR Analysis

Real-time accounts receivable dashboards give revenue cycle managers instant visibility into aging, payer performance, and cash flow trends - with predictive analytics identifying at-risk claims before they become write-offs.

Aging Analysis

0-30, 31-60, 61-90, 90+ day buckets by payer and provider

Predictive Risk Scoring

AI flags claims likely to be denied or aged out within 7 days

Payer Scorecards

Reimbursement rate, denial rate, and TAT tracked per payer

Exportable Reports

CFO-ready PDF/Excel reports with one-click generation

6

Denial Management

Systematic denial resolution with AI-generated root-cause categorization, smart appeal letter generation, and a denial prevention feedback loop that continuously reduces your upstream denial rate over time.

Root-Cause Categorization

Denials classified by reason code, payer, and denial type automatically

Appeal Letter Generator

Payer-specific appeal letters with clinical documentation auto-attached

Denial Trend Analysis

Pattern recognition surfaces systemic coding or billing issues upstream

Resubmission Tracking

Full audit trail of every denial, appeal, and resubmission outcome

7

AR Calling

AI-prioritized calling queues ensure your AR team focuses on the highest-value, most time-sensitive claims - with pre-call claim summaries, payer contact scripts, and post-call disposition logging built into every interaction.

AI-Prioritized Queue

Claims ranked by balance, days outstanding, and recoverability score

Pre-Call Brief

Complete claim history, prior contacts, and payer notes before dialing

Disposition Tracking

Call outcome logged with next follow-up date auto-scheduled

Performance Dashboards

Collector productivity, resolution rate, and collections-per-hour tracked

Your Complete RCM - Automated & Intelligent

See all 7 workflow stages in a live demo customized for your specialty and payer mix.