MedSole RCM

MedSole RCM: Medical Billing and Revenue Cycle Management for U.S. Practices

MedSole RCM is a revenue cycle management (RCM) services company serving private practices, hospitals, and medical practices in the United States. Its approach is to outsource medical billing and associated processes, operating within the electronic health record (EHR) system the client already uses, without changing its internal operations. The company states that the transition to its services is completed and the first live claims are submitted within 7 to 10 days.

Services Included in the Flat Rate

The company bundles all its services under one team and one flat rate, with no additional charges or line-item invoicing. The catalog includes:

• Medical billing: submission of coded claims and follow-up through to payment.
• Complete revenue cycle management, from patient registration to final payment posting.
• Credentialing and contracting with insurers: submission of provider enrollment applications, weekly follow-up, and tracking through approval.
• Real-time eligibility verification before every encounter: active coverage, copay, deductible, and prior authorization requirements.
• Prior authorization: obtaining insurer approvals before the procedure date.
• Payment posting and reconciliation: recording ERA and EOB payments on the day of receipt, matching against billed charges, and detecting contractual discrepancies.
• Accounts receivable (A/R) follow-up: daily management of aging claims, prioritized by value and proximity of the filing deadline.
• Denial management: categorization by reason code, appeal with clinical documentation, and root-cause correction.
• Patient registration and demographic data entry.
• Claims submission.
• Performance reporting.
• Virtual assistance.
• Remote patient monitoring (RPM).

As additional services, the company mentions dental billing and healthcare marketing.

Eight-Step Work Process

MedSole describes its operations as a connected system in which each stage depends on the previous one. The process begins with a discovery and setup phase (days 1 to 7), in which it reviews the client's EHR, payer mix, fee schedules, denial history, and A/R aging report, and assigns a dedicated billing team with access configured under role-based permissions. Then, before each encounter, it verifies the patient's coverage in real time. In the submission phase, it captures daily charges by reconciling the schedule against entered encounters and reviews ICD-10, CPT, and HCPCS codes against provider documentation, applying payer-specific edit logic (bundling conflicts, modifier requirements, and place-of-service rules). After payment, it posts and reconciles ERA and EOB payments on the same day of receipt, categorizes denials by reason code, appeals them with clinical documentation, and corrects the root cause. Finally, it performs daily follow-up on aging accounts receivable and delivers regular performance reports with collections by payer, denial rates by category, days in A/R by aging bucket, and recommended adjustments.

Specialties and Systems Covered

The company states it covers more than 75 medical specialties, including acupuncture, allergy and immunology, anesthesia, behavioral health, cardiology, chiropractic, dentistry, dermatology, emergency medicine, endocrinology, ENT/otolaryngology, family medicine, gastroenterology, general surgery, geriatrics, hematology, hepatology, hospital medicine, infectious disease, internal medicine, mental health, nephrology, neurology, obstetrics and gynecology, oncology, ophthalmology, optometry, oral and maxillofacial surgery, orthopedics, pain management, pediatrics, physical medicine and rehabilitation, physical therapy, plastic surgery, podiatry, primary care, psychiatry, pulmonology, radiology, rheumatology, sleep medicine, speech therapy, telemedicine, thoracic surgery, toxicology, urology, urgent care, vascular surgery, and wound care, among others. It also notes that it supports more than 50 EHR/EMR systems.

Fees and Commercial Terms

The site states that medical billing services start at 2.99% of monthly collections and that credentialing starts at $99 per insurer. The company states that it does not charge setup fees or require long-term contracts, and offers a free, no-obligation billing analysis. These terms correspond to the information published at the time of analysis and may change.

Reported Performance Metrics

MedSole RCM publishes performance figures that, according to its presentation, come from active practice accounts: 99% first-pass claim acceptance, 99.8% coding accuracy, 24 days average accounts receivable, more than $200 million in claims managed, 30% faster payment cycles, an average revenue improvement of 10% to 15%, a 20% reduction in A/R aging, 100% payer-compliant formatting and audit-ready documentation, and 99% documentation-backed claims. These are data provided by the company itself.

Client Profile and Compliance

The company targets its services at private practices, hospitals, and medical practices, and states it operates in compliance with HIPAA regulations. Its model is based on a dedicated billing team per client, weekly performance reports, and access configured through role-based permissions within the client's own system.