Eligibility & Benefit Verification
Verify patient insurance coverage, deductibles, co-pays, and plan details before the encounter to eliminate front-end denial triggers.
Learn MoreMedical Coding
Expert certified documentation audits mapping clean ICD-10, CPT, and modifier selections to guarantee optimal payment accuracy.
Learn MoreCharge Entry
Daily entry of patient demographics, fee schedules, and clinical superbills with detailed internal scrubbing audits.
Learn MoreClaims Submission
Electronic clearinghouse claims dispatch completed within 24 hours of entry, maintaining a 99% clean claim benchmark.
Learn MorePayment Posting
Rapid ledger credit updates from ERAs and paper checks, reconciling payments, and immediately identifying contract variance underpayments.
Learn MoreDenial Management
Prompt 48-hour response appeals for payer denials. Root-cause audits mapped to permanently resolve recurring denial trends.
Learn MoreAR Follow Up
Proactive follow-up with insurance carriers on aged claims, ensuring suspended collections are resolved and reimbursed quickly.
Learn MorePatient Collections
Patient statement cycles, portal payment setup, and friendly patient service lines to minimize outstanding accounts receivable.
Learn MoreCredentialing & Enrollment Services
Complete provider credentialing, CAQH database maintenance, and insurance panel enrollment to keep collections active.
Learn MoreWhy Outsource Revenue Cycle Management to Malakos?
Managing the healthcare billing ecosystem in-house takes clinical focus away from patients and places administrative strain on staff. Malakos Healthcare Solutions resolves this by deploying specialized billing experts and HIPAA-compliant automation pipelines. We optimize every touchpoint of your billing workflow, from initial insurance verification to final denial recovery, minimizing compliance risks and maximizing cash flow.
Our Operational Workflow
Patient Intake & Verification
Benefits and eligibility checked prior to the visit, checking for active coverage and copays.
Scrubbing & Electronic Submission
Coding check protocols verify ICD-10 and modifier alignments before claims are sent to clearinghouses.
Denial Resolution & Posting
Prompt payment allocation postings combined with 48-hour denial appeal tracks for lost cash.
Frequently Asked Questions: Medical Billing & RCM
Find answers to the most common questions regarding outsourced medical billing, coding compliance, and how Malakos helps clinics secure maximum reimbursement.
Revenue Cycle Management (RCM) is the comprehensive financial process that healthcare facilities use to track patient care episodes from initial registration and scheduling to the final collection of outstanding balances.
This includes front-end processes (eligibility verification, prior authorization), middle-office functions (medical coding, charge entry), and back-end collections (claims submission, payment posting, denial management, and patient statements).
Medical coding translates clinical documentation into standardized CPT, ICD-10, and HCPCS codes. Inaccurate coding leads directly to claim rejections, payment delays, audits, and compliance violations.
Our certified AAPC/AHIMA coding reviews ensure modifiers, bundling guidelines, and diagnosis pairings are mapped precisely, capturing full allowed rates and reducing audit exposures.
The clean claim rate measures the percentage of claims submitted to clearinghouses and payers that are successfully processed and paid on the first submission without rejections or code edits.
Malakos maintains a 99% clean claim rate. By scrubbing code edits and verifying eligibility rules before transmission, we prevent cash flow bottlenecks and avoid costly manual claim rework loops.
When a denial is posted, our specialized denial management team tracks the claim timeline, isolates the specific reason code (CARC/RARC), and files structured appeals with clinical letters within 48 hours.
We perform weekly root-cause audits on claim rejections to implement workflow updates, correcting underlying registration or coding issues so those specific denials do not reoccur.
Yes. Malakos operates under strict HIPAA security protocols to protect Protected Health Information (PHI). We use encrypted EHR integrations, secure cloud connections, and require continuous compliance certification for all billing and support agents.