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AltuMED Smart RCM Engine
A Controlled Revenue Production System
Built as a multi-zone assembly line that ensures every claim is engineered, routed, and optimized for maximum yield. A specialized system that self-improves with every cycle
Revenue Cycles Shouldn’t Be Unpredictable
Most healthcare practices run RCM as a workflow consisting of a collection of disconnected tasks. Major processes like charge entry, coding, submission, posting, and followups work in silos. This workflow offers no meaningful communication between the front desk that gathers insurance info, coders who prepare claims, and billers who handle denials. The resultant high rate of errors leads to unpredictable cash flow and surprise denials. Not to mention, much of the job involves manual efforts, which add significantly to the administrative burden on an already overwhelmed clinical staff
A smart, fully synced RCM system is the best answer to all these problems.
Introducing Smart RCM Engine
AltuMED’s Smart RCM Engine is a multi-zone, highly synchronized revenue production system that grows while optimizing each claim. It is like an intelligent assembly line working on predefined protocols. But there is also a distinction. The production on a traditional assembly line stops when there is an error. In the RCM Engine, an error triggers a contingency. The faulty claims get rerouted, corrected, and reprocessed, all without halting the workflow.
The Smart RCM Engine relies on four intelligently engineered pillars. These pillars bring accuracy, speed, and maximum yield, which ultimately translate into a higher Net Collection Rate and reduced days in AR.
SMART RCM ENGINE
Pillar 1
Intelligence
RCM Engine’s Intelligence uses AI and ML algorithms that govern your entire revenue workflow. These specialized algos ensure that every claim is built to pass. Their signature feature is the predictive claim scrubbing platform that checks every claim against millions of historical data points and payer policies. Not only does it check for blank fields, it also ensures every claim explains complete clinical logic.
Pillar 2
Revealer
Practice owners want to see their unbilled AR, denial rates, and cash flow inconsistencies today. With Revealer, they can look into these KPIs on demand. They get real-time financial transparency required to make targeted decisions for an improved cash flow.
Pillar 3
Continuous Optimization
This pillar manages the system’s feedback loop. The intelligence from every error that gets fixed is fed back into the system. The system also learns from denied claims and updates its operational protocols based on corrections to prevent such denials from happening in the future.
Pillar 4
Smart Flow
Not all claims share the same workflow. A standard claim will probably pass through using a standard process. But a complex oncology claim will need different attachments and handling protocols. RCM Engine's Smart Flow system identifies these requirements and deploys appropriate protocols to ensure every claim gets processed on its merits.
SMART RCM ENGINE
How RCM Engine Works
The four layers explained above set the RCM logic. But the exact framework is defined by a multi-zone architecture. It is the very system that replaces a disconnected RCM workflow with a fully connected and synchronized mechanism where all processes communicate with each other. It consists of the following five zones.
Zone 01
Quality Gate
Zone 01
Capture
This is where the RCM 'production line' starts. Although its name implies data capturing, it does much more than that. It is more like a 'quality gate' where the claim's initial data gets fully scrutinized for completeness. It checks each claim for critical information like patient registration, eligibility, and prior authorizations.
Zone 02
Structure
This zone is the RCM Engine's fabrication floor where the raw data coming from the first zone gets compiled into a complete claim. It assigns CPT/ICD-10/HCPCS codes to the medical services documented in the claim. It also performs scrubbing to remove documentation errors. Modifier logic explanation and medical necessity validation against LCD/NCD policies are also performed in this phase.
Zone 03
Dispatch
This zone receives a complete claim from the preceding zones and routes it through clearinghouses. It uses the EDI 837 electronic transaction set to ensure that the submission remains HIPAA-compliant. This zone also simultaneously tracks each claim status in real time. This helps healthcare providers know where their claims stand.
Zone 04
Realize (Reconcile)
This is the receiving inspection station. It performs outcome verification through efficient payment posting. The purpose is to detect underpayments by comparing the payments against contracted rates to ensure proper reconciliation. It also calculates patient responsibility balances to ensure accurate record closure.
Zone 05
Recover
This is your exception handling platform. Or simply, it is a rework station that looks into denials and ARs to identify their root causes. It then generates detailed reports to help accelerate recovery. It also prioritizes follow-ups based on the claims' recoverability and dollar value. And the best part, the system uses this feedback to improve the workflow.
Zone 1 of 5
One Platform, Three Ways To Operate
Every practice has unique requirements. Some may want to delegate the entire RCM operation. Some may see it viable to retain their revenue team and upgrade the platform. The following three models offer appropriate frameworks to meet particular needs of all these practices.
Model 1
FullStack RCM
(Run It For Me)
With this model, you outsource your entire RCM's ownership to AltuMED. We deploy the RCM engine and the revenue team to take care of everything from intake validation all the way to payment posting and patient collections. What you get in terms of operational workload is performance visibility and the autonomy to ensure optimal patient care.
Who Is It For?
- Growing practices
- Limited or underperforming billing teams
- Practices struggling with high denial rates
Model 2
Co-Managed RCM
(Run It With Me)
Practices that want to stick with their in-house billing teams but are looking for structural performance improvement can choose this model. As the name suggests, this model allows tasks to be split between your team and AltuMED. The Smart RCM Engine routes tasks between both your and AltuMED's teams.
Who Is It For?
- Mid-maturity RCM teams
- Organizations open to collaboration
- Practices that want measurable improvements without disruption
Model 3
Platform-Led Performance
(Power My Team)
Large organizations and MSOs usually cannot take their RCM outside the facility for confidentiality reasons. The best they can do is strengthen their existing revenue infrastructure. The Platform-Led Performance model offers advanced automation and payer intelligence to fulfill this requirement. It essentially eliminates their need to outsource any part of their workflow. It is a complete deployment that helps them avoid performance bottlenecks and improve cash flow.
Who Is It For?
- Existing billing teams looking to improve efficiency
- Practices relying on private equity
- Organizations with strict data security protocols
Proven Results
Proven Results and Metrics
AltuMED’s Smart RCM Engine turns your chaotic revenue cycles into measurable production lines. As a result, you get a consistent financial yield. The data below should explain how each zone uplifts your revenue standing:
OUTCOMES ACCROSS EVERY ZONE
99%
Clean Claim Rate
First-pass production yield captured at the front of the line.
97.35%
Coding Accuracy
Validated structuring across every specialty and payer rule.
97.35%
First-Pass Acceptance
Claims accepted clean on initial submission to payers.
+30%
Avg. Collection Increase
Measured uplift in collections across active deployments.
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AltuMED proudly serves healthcare providers across the United States. We understand regional billing regulations and payer relationships in all 50 states.