Maximize Your Healthcare Revenue with Expert
Medical Coding - 100% Accuracy Guaranteed with Prime RCM
Our medical coding services eliminate costly errors, slash claim denials by 50%, and accelerate reimbursements for healthcare providers across the United States.
Our AAPC/AHIMA-certified coders specialize in U.S.-specific coding standards, including ICD-10, CPT, and HCC coding. We convert complex clinical documentation into error-free claims, and we empower hospitals, ASCs, and specialty practices to reduce administrative burdens and reclaim lost revenue. Trusted by providers in all 50 states, our proven 98% claim acceptance rate guarantees faster payments and a streamlined revenue cycle.
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What is Medical Coding?
Medical coding is the process of translating healthcare diagnoses, procedures, and treatments into standardized alphanumeric codes used in the United States. These codes—like ICD-10 for diagnoses, CPT for procedures, and HCPCS for equipment—act as a universal language between healthcare providers, insurers, and regulators. They ensure accurate billing, streamline insurance claims, and maintain clear patient records. Without precise coding, providers risk delayed payments, claim denials, or compliance issues under U.S. healthcare laws.
Prime RCM
Medical Coding Solutions for US Healthcare Providers
Prime RCM provides complete medical coding services designed to optimize accuracy, compliance, and financial outcomes for healthcare providers in the USA. Our AHIMA-certified coders ensure precise translation of clinical documentation into codes compliant with CMS, Medicare, and U.S. payer guidelines.
Inpatient Medical Coding
Inpatient Medical Coding
Prime RCM’s inpatient coding specialists excel in ICD-10-CM and ICD-10-PCS coding, ensuring accurate representation of diagnoses and procedures for hospital stays. Our certified coders conduct thorough DRG validation and MS-DRG optimization, aligning documentation with Medicare Severity Diagnosis-Related Groups (MS-DRGs) and Inpatient Prospective Payment System (IPPS) guidelines. By capturing the complexity of inpatient cases, we reduce claim denials by 50% and enhance reimbursement accuracy for critical care, surgical interventions, and long-term hospitalizations.
Outpatient & Ambulatory Surgical Center (ASC) Coding
Outpatient & Ambulatory Surgical Center (ASC) Coding
Accurate outpatient coding is vital for clinics, ASCs, and emergency departments. Prime RCM’s coders specialize in CPT, HCPCS, and modifier assignments, including telehealth-specific codes such as POS modifiers and virtual care CPT guidelines. We ensure compliance with evolving CMS regulations for Evaluation and Management (E/M) codes, reducing billing delays and accelerating revenue cycles. Our 48-hour turnaround guarantee and 99% accuracy rate empower outpatient facilities to maintain cash flow while adhering to payer-specific requirements.
HCC Coding & Risk Adjustment
HCC Coding & Risk Adjustment
Hierarchical condition category coding is critical for Medicare Advantage plans and U.S. commercial risk adjustment programs. Prime RCM’s certified coders analyze clinical documentation to assign precise RAF scores, capturing patient complexity and chronic conditions. We ensure compliance with CMS-HCC and HHS-HCC models, optimizing reimbursements while preparing practices for RADV audits. By improving documentation specificity and RAF accuracy, we help providers increase risk-adjusted revenue by 20% and mitigate audit risks.
Denial Management & Appeals Resolution
Denial Management & Appeals Resolution
Prime RCM addresses coding-related claim denials through root-cause analysis, identifying errors such as incorrect modifiers, mismatched ICD-CPT codes, or incomplete documentation. Our team resubmits appeals with OIG-complaint rebuttals, achieving a 90% success rate in overturning denials. We prioritize high-impact denials to recover aged receivables and reduce write-offs.
Backlog Reduction & DNFB Management
Backlog Reduction & DNFB Management
Delayed coding impacts revenue cycles. Prime RCM resolves Discharged Not Final Billed (DNFB) and Discharged Not Finally Coded (DNFC) cases with rapid coding workflows, reducing DNFB days by 70%. Our real-time coding dashboards provide visibility into backlog status, enabling proactive resource allocation.
Case Mix Index (CMI) Enhancement
Case Mix Index (CMI) Enhancement
For hospitals, optimizing CMI is key to reimbursement. Our coders ensure accurate MS-DRG assignments, capturing comorbidities and complications to reflect patient acuity. This results in a 15% increase in CMI, directly boosting revenue per case and aligning payments with care complexity.
Custom Coding Solutions According to Your Practice
Custom Coding Solutions According to Your Practice
We know that everyone's healthcare coding practices are not the same. That’s why we offer custom coding solutions designed to meet your unique needs—whether you’re a small clinic, a multi-specialty group, or a large hospital system. From ICD-10-CM and CPT coding for specific specialties like cardiology or orthopedics to HCC coding for Medicare Advantage plans, our AAPC/AHIMA-certified coders deliver precision and flexibility. We adapt to your workflows, integrate seamlessly with your EHR, and scale with your growth, ensuring you get the right level of support without unnecessary costs. With per-chart pricing, monthly subscriptions, or on-demand staffing, we provide cost-effective options that fit your budget while maximizing your revenue. Let us create a coding solution that works as hard as you do.
Technology-Driven Coding Solutions
Technology-Driven Coding Solutions
Prime RCM integrates AI-powered tools with human expertise to enhance efficiency. Our proprietary NLP algorithms analyze clinical notes to suggest ICD-10 and CPT codes, reducing manual errors. Seamless EHR/EMR compatibility with Epic, Cerner, and Meditech ensures real-time data synchronization, while HIPAA-compliant workflows with SOC 2 and ISO 27001 certifications safeguard PHI.
Prime RCM
Importance of Accurate Medical Billing
Medical billing is the lifeline of healthcare revenue cycles, ensuring providers are paid accurately and promptly for the care they deliver. It bridges clinical services with financial sustainability by translating treatments, diagnoses, and procedures into standardized codes for insurance claims. Without efficient billing, practices risk delayed payments, compliance penalties, and strained patient relationships. Here’s why medical billing matters:
Ensures Financial Stability & Cash Flow
Ensures Financial Stability & Cash Flow
Accurate medical billing guarantees timely reimbursements from insurers, directly impacting a practice’s cash flow. Delays or errors in coding (like ICD-10, CPT, or HCPCS) lead to underpayments or denials, disrupting a clinic’s ability to cover operational costs, pay staff, or invest in new technology.
Minimizes Claim Denials & Revenue Loss
Minimizes Claim Denials & Revenue Loss
Up to 30% of claims are denied due to coding errors or missing documentation. Robust billing processes identify mistakes early—such as mismatched codes or incomplete patient data—reducing denials by 50% and recovering revenue that would otherwise be lost forever.~
Maintains Regulatory Compliance
Maintains Regulatory Compliance
Medical billing must adhere to strict regulations like HIPAA (patient privacy), CMS guidelines, and payer-specific rules. Non-compliance risks audits, fines, or legal action. Proper billing ensures alignment with evolving laws, such as telehealth coding updates or value-based care requirements.
Builds Patient Trust & Satisfaction
Builds Patient Trust & Satisfaction
Transparent billing practices eliminate confusion. Clear statements and upfront cost estimates reduce disputes over unexpected charges, fostering patient loyalty. Automated tools also let patients access payment plans or explanations of benefits (EOBs) easily.
Streamlines Operational Efficiency
Streamlines Operational Efficiency
Manual billing consumes hours of staff time. Automated systems track claims status, flag unpaid invoices, and generate reports, freeing teams to focus on patient care. This reduces administrative burnout and lowers overhead costs.
Supports Data-Driven Decision-Making
Supports Data-Driven Decision-Making
Billing data reveals trends like frequent denials from specific payers, seasonal revenue dips, or coding errors. These insights help clinics negotiate better payer contracts, optimize workflows, and allocate resources strategically.
Enhances Patient Record Accuracy
Enhances Patient Record Accuracy
Precise billing relies on detailed clinical documentation. This improves EHR integrity, ensuring records reflect accurate diagnoses and treatments. Better documentation supports care coordination, reduces errors, and improves treatment outcomes.
Strengthens Payer Relationships
Strengthens Payer Relationships
Clean, error-free claims are processed faster, building trust with insurers. Consistent accuracy minimizes disputes and fosters long-term partnerships, ensuring smoother reimbursements and fewer delays.
Compliance Framework:
Your Shield Against Risk
Compliance is the foundation of our medical coding services. We rigorously adhere to U.S. regulations, including HIPAA, CMS guidelines, and OIG standards. We ensure every ICD-10, CPT, and HCPCS code aligns with regulatory requirements. Our AAPC/AHIMA-certified coders stay ahead of evolving rules—from annual CPT updates to telehealth coding mandates—through continuous training and real-time audits.
By integrating AI-driven compliance checks and quarterly CMS reviews, we eliminate risks like claim denials, audit penalties, or revenue loss. With SOC 2 and ISO 27001-certified workflows, encrypted data handling, and transparent reporting, we turn compliance into your greatest asset—protecting your practice while maximizing reimbursements.
Why Choose Prime RCM?
At Prime RCM, We don’t just code—we safeguard your revenue, ensure compliance, and transform clinical documentation into financial success. Here’s why leading hospitals, ASCs, and specialty practices trust us:
AAPC/AHIMA-Certified Coding Experts
Our coders hold U.S.-recognized credentials with expertise in Medicare, Medicaid, and commercial payer requirements. Our coders hold AAPC and AHIMA credentials, with 10+ years of experience in ICD-10-CM, CPT, and HCPCS coding. They stay ahead of CMS updates, OIG guidelines, and payer-specific rules, ensuring audit-ready accuracy and reducing compliance risks.
99% Accuracy with 48-Hour Turnaround
Speed meets precision. We code charts within 48 hours while maintaining a 99% accuracy rate, slashing claim denials, and accelerating reimbursements. No more delays—just faster payments and a healthier cash flow.
Specialty-Specific Coding Teams
Your specialty deserves specialized expertise. Whether it’s cardiology, orthopedics, or HCC coding for Medicare Advantage, our coders are trained in your field. This ensures precise DRG assignments, RAF score optimization, and error-free E/M coding for complex cases.
24/7 Support & Dedicated Account Managers
Coding emergencies don’t wait. Our 24/7 support hotline connects you to certified coders and account managers who resolve issues in real time. From denied claims to urgent coding reviews, we’ve got your back—nights, weekends, and holidays.
Compliance-First Approach
We align with U.S. healthcare regulations, including HIPAA, MACRA, and CMS audits, to safeguard your practice.HIPAA, GDPR, and MACRA compliance are non-negotiable. Our SOC 2 and ISO 27001-certified workflows encrypt PHI, while quarterly audits ensure adherence to CMS and payer guidelines. Sleep easy knowing your coding is bulletproof.
AI-Driven Technology for Unmatched Efficiency
We combine human expertise with AI-powered tools to automate code validation, reduce manual errors, and integrate seamlessly with EHRs like Epic and Cerner. Real-time dashboards track claim status, denial trends, and revenue impact, putting you in control.
Proven Results, Zero Risk
- 98% Claim Acceptance Rate: Fewer denials, faster payments.
- 50% Backlog Reduction: Slash DNFB (Discharged Not Final Billed) days.
- 40% Cost Savings: Offshore teams deliver premium quality at half the cost.
Our Proven
Medical Coding Process
At Prime RCM, we specialize in accurate, ethical, and optimized medical coding. Our certified coders ensure you capture every dollar earned while staying compliant. Here’s how our systematic approach adds value to your practice:
Accurate Encoding
Our expert coders translate medical charts into precise ICD-10, CPT, and HCPCS codes. This ensures error-free documentation for billing and compliance.
Timely Payments
We close tickets only after claims are accepted and payments are received. This guarantees no revenue is left behind.
Code Assignment
We identify the most relevant codes from medical classifications and integrate them into your system. This maximizes reimbursements and minimizes claim denials.
Quality Review
Every code is double-checked for accuracy, including DRG (Diagnosis-Related Group) for case-mix financing. This step ensures compliance and proper reimbursement.
Billing Advocacy
Our team works directly with payers to resolve denied claims and secure fair reimbursements. We fight for every dollar you’re owed.
Patient Data Security:
Risks & How Prime RCM Protects Your Information
Healthcare data breaches can cripple practices and erode patient trust. At Prime RCM, we tackle risks head-on with robust safeguards. Below, we break down key threats and how we counter them:
Risks to Patient Data:
Prime RCM’s Security Solutions
Prime RCM
Why Should You Trust Prime RCM?
Zero Breach History
Secured 10M+ patient records without a single breach.
Staff Training
Yearly HIPAA workshops and quarterly phishing simulations keep teams alert.
24/7 Monitoring
Real-time alerts and rapid response teams neutralize threats instantly.
Prime RCM:
Secure Your Practice with Prime RCM
Don’t risk fines or patient trust. Our proactive security keeps data safe and compliance stress-free. At Prime RCM, we don’t just provide medical coding services—we deliver peace of mind. With 99% accuracy, a 48-hour turnaround, and HIPAA-compliant workflows, we ensure your claims are error-free, audit-ready, and optimized for maximum reimbursements. Our AAPC/AHIMA-certified coders, advanced AI tools, and 24/7 support are here to protect your revenue, reduce denials, and simplify compliance. Ready to transform your revenue cycle?
What is medical coding, and why is it important?
Medical coding translates healthcare services (diagnoses, treatments, and procedures) into universal alphanumeric codes. These codes are used for billing, insurance claims, and patient records. Accurate coding ensures proper reimbursement and compliance with regulations like HIPAA.
How do medical coding services reduce errors?
Professional coders use advanced software and follow strict guidelines (e.g., ICD-10, CPT, HCPCS) to ensure accuracy. Regular audits and training minimize errors, preventing claim denials and revenue loss.
Can medical coding services help with claim denials?
Yes! Expert coders identify and fix coding errors that cause denials. They also ensure claims meet payer-specific requirements, reducing rejections and speeding up reimbursements.
Are medical coding services HIPAA-compliant?
Reputable services like Prime RCM follow HIPAA guidelines strictly. They use encrypted systems, secure data transfers, and train staff to protect patient information.
How much do medical coding services cost?
Costs vary based on practice size, specialty, and service scope. Many providers offer flexible pricing, such as per-claim fees or monthly subscriptions, to fit your budget.
