Advisory
You have a capable biller and need a senior person to check the work and set direction.
- Monthly KPI review and written summary
- Denial and AR trend oversight
- On-call guidance for your billing team
Services
Director-level RCM, in the shape your practice needs.
Get credentialed and contracted, diagnose what's wrong, fix it at the source, and keep it running — for behavioral health, psychiatric, ABA and physical therapy practices. All work is done by a 100% US-based team.
01 · Diagnose
Revenue Cycle Assessment
A fixed-scope diagnosis. We pull your claims, remittances, payer contracts and AR, and show you exactly where revenue is being lost — and what to fix first.
Best for: practices that know something is off and want it quantified.
- Denial analysis by root cause and dollars
- Contract-to-payment variance by payer
- AR aging, sorted by recoverability
- Front-end review: intake, VOB, authorizations
- KPI baseline with written definitions
- Prioritized 90-day fix list with owners
02 · Run
Full-Service Billing
Your billing handled end to end by a US-based team — no offshore resources — with director-level oversight built in rather than sold separately.
Best for: practices without an in-house billing team, or ready to replace a vendor they can't see into.
- Charge review and claims scrubbing
- Claims submission
- Payment posting and reconciliation
- AR follow-up and denial management
- Underpayment monitoring against contracts
- Monthly KPI report with written definitions
- A transition plan for AR left with your old vendor
03 · Lead
Fractional RCM Leadership
Keep your own billers or vendor, and add a director on top. Choose how involved you want us to be.
Hands-on
You need the fixes actually carried out, with someone leading the team through them.
- Everything in Advisory
- Process and workflow fixes
- Payer escalations and contract follow-up
- Weekly check-in with leadership
Embedded
You need an acting Director of RCM through growth, a system change or a leadership gap.
- Everything in Hands-on
- Direct management of billing staff or vendor
- EHR and payer configuration oversight
- Owner- or board-ready monthly reporting
04 · Fix
Project Work
Scoped work with a clear finish line, for a specific problem you already know you have.
- Charge master and fee schedule clean-up
- Billing data review to surface recoverable revenue
- Workflow and SOP documentation
- Billing staff training
- KPI and reporting setup
- Billing vendor evaluation and transition
05 · Get in network
Credentialing & Payer Contracting
Most revenue problems start before the first claim: a provider who isn't enrolled, a contract nobody has read closely, or rates that were never loaded correctly. We handle the upstream work so claims can be paid right the first time.
Best for: new practices and locations, adding providers or payers, or practices that suspect their contracts are underpaying.
Credentialing & enrollment
- Provider credentialing and re-credentialing
- CAQH profile setup and attestation upkeep
- Medicare and Medicaid enrollment
- Commercial payer enrollment
- Group, facility and individual provider linkage
- Expiration and revalidation tracking
Payer contracting
- Contract review: rates, terms, timely filing, carve-outs
- Payer-by-location contract matrix
- Contracted rates loaded correctly in your EHR
- Contract-to-payment variance monitoring
- Network participation requests
- Renegotiation prep, backed by your own data
Common questions
Do we have to start with the assessment?
Usually, yes. It's how we both find out whether the problem is people, process, payers or the system — and it sets the baseline we measure against.
How soon will we see results?
The assessment delivers its findings within 24–48 hours of receiving your data. Fixes made at the source usually show up in the next few months of denial and clean-claim numbers. Slower items, like payer contract changes, are flagged as such in the 90-day plan.
Which numbers will you report?
First-pass clean claim rate, denial rate by reason and payer, net collection rate, days in AR, and AR over 90 and 120 days. Each has a written definition, so the numbers mean the same thing every month.
We already have a billing company. What happens to our open claims if we switch?
Before cutover we agree in writing who owns the legacy AR — your old vendor, your staff or us — and how it gets worked to resolution. We also confirm clearinghouse and payer enrollment details, so new claims don't stall during the change.
Can you get us in network with a payer?
We handle the credentialing, enrollment and participation requests, and build the case for your rates. Whether a network accepts you, and at what rate, is always the payer's decision — we make sure nothing on your side slows it down.
Do you use offshore staff?
No. Everyone who works on your account is based in the United States — for advisory work and full-service billing alike.
How do you handle patient data?
Only US-based staff access your data. A Business Associate Agreement is signed before we access any PHI, and data is returned or destroyed — with a written certificate — when the engagement ends.
Do you work with SUD programs covered by 42 CFR Part 2?
Yes. Our background is in substance use disorder and behavioral health billing across multi-state facility groups. We check that the required Part 2 consent is in place before records go to a payer, and we treat SUD records under Part 2's re-disclosure rules.
Who owns our data if we stop working together?
You do. We work in your own systems wherever possible, so your claim history, reports and payer setup stay with you. Anything we hold is returned or destroyed at the end, and open work is handed off in writing.
Do you use AI or automation?
Yes, to find patterns and prioritize work faster. A person reviews every claim, appeal and payer communication before it goes out, and patient data only goes into tools covered by a Business Associate Agreement.
Will you replace our billing staff?
Not unless you want us to. Fractional leadership makes your existing team or vendor more effective. Full-service billing is a separate option.
Not sure which fits?
Thirty minutes with Daniel, SPR Group's founder. You'll leave knowing which service — if any — makes sense.