Revenue cycle management

Capitalize on our proven track record of exceeding expectations for financial clearance, coding accuracy, cash recoveries, and denial reversals

Tracking, managing, and collecting revenue throughout the patient lifecycle — from the patient’s initial interaction with the healthcare organization, through to gaining prior authorizations for treatment from their insurers, all the way to paying the final balance — has become an area of specialty in and of itself. Revenue cycle management (RCM) now often requires dedicated resources for coding, prior authorizations, clinical denials, billing/collections, records management, etc.

Facing the need to interact with many types of patients and payers with varied policies and approaches, hospitals and other healthcare providers have traditionally hired in-house professionals (including precious clinicians!) to manually review patient cases, navigate a multitude of systems, and liaise with insurers, clinicians, and patients with differing agendas. They frequently run into resource limitations with this conventional, manual approach.

Engaging a business process management company (with access to thousands of experienced nurses and healthcare specialists) and applying modern technology — such as analytics, automation, and artificial intelligence (AI) — can more reliably, more efficiently, and more quickly recover much-needed revenue.

All too often, US hospitals write off receivables and denied claims — to the tune of $262 billion per year, or 2-3% of net patient revenue. Outsourcing to HGS can increase the revenue collected and lead to more effective clinician allocation. Let us help you help more patients.

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How we do it

Our suite of services includes front-end patient access services; mid-cycle charge integrity, medical coding, and billing services; and back-end insurance claims resolution offerings, administrative and clinical denial appeals, and customer-driven self-pay early-out services.

The value of HGS RCM services

The numbers speak for themselves.

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Accounts receivable

More than $6.9 billion in client accounts receivable are managed and $2.6 billion in cash recovered.

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We have processed more than 60 million hospital, physician, and DME claims.

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Denial reversal

We have reversed more than 8 million zero-paid denials, resulting in $950 million in recovered payments.

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Denial reversal on aged claims

Denial reversals and cash recovered on claims aged >1 year from discharge often cover cost of service.

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Cash recovery

Cash recoveries exceed client baselines by an average of +21%.

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Multi-source cash recovery

$3 billion in cash recovered, including $1.5 billion in denial reversals.

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Client satisfaction

100% of clients surveyed state that they would use HGS’s RCM services again.

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