Accelerate the speed and accuracy of turning Charges into Revenue

Industry changes are leading more and more provider organizations to capture Charge information—CPT and ICD-10 codes—in the EMR.

But physicians are clinical experts, not billing and coding specialists. This forces medical groups to manually review all charges passing from the EMR for billing and coding accuracy—which adds time, effort, and expense to the charge capture process.

We have a better way.

RCxRules cleans data at the most efficient spot—the front end

While traditional claim scrubbers were valuable in the past, they’ve become outdated and inadequate. That’s because they sit at the back-end of the process, after charge transactions have been posted to your revenue cycle management system (RCM)—and in today’s dynamic and complex healthcare world, that’s simply too late.

Instead, RCxRules works on the front end of your process, automatically reviewing and correcting Charges before they hit your revenue cycle management system (RCM). By leveraging a robust data model and modern technology RCxRules easily integrates with your existing EMR and RCM system.

This game-changing advantage virtually eliminates the need for time-consuming Charge correction and reposting.

RCxRules delivers automated data-correction capabilities that is unprecedented

The RCxRules system reviews Charges not only against industry-standard requirements—but against customized, high-value rules tailored to your organization’s specific needs.

Then our unique Auto Correct functionality automatically fixes routine issues to ensure that clinical encounters are appropriately and compliantly formatted to meet your payers’ billing and administrative requirements.

RCxRules enables simple rule customization

Our industry-leading healthcare rules engine is purpose-built to help medical groups get paid faster with less effort—and simple and efficient rule creation is an essential component of this objective. Leveraging modern technology allows RCxRules users to quickly and efficiently write customer-specific rules.

By leveraging both industry-standard rules and tailored, high-value rules customized to your unique requirements, RCxRules significantly accelerates the process of submitting clean, payment-ready charges to your payers. Faster charge processing and reduced denials translate to increased reimbursements and improved payment velocity.

With RCxRules, you get paid faster with less effort.


Make it work for you, not against you

The process for risk scoring and HCC coding may sound confusing, but at its core, HCC coding is based on good clinical practice. Providers have been delivering great patient care for decades, but to excel in this new world of Risk Adjustment and HCC coding, they also must ensure that the care their patients receive is fully documented in the medical record—and that the diagnosis coding is comprehensive.

To conquer HCC coding, the patient’s ICD-10 diagnosis profile must be robust.

That’s where RCxRules comes in. We make sure your patient’s diagnosis profile is appropriate, complete and specific.

How HCC coding works

Hierarchical Condition Categories (HCCs) are derived from the underlying ICD-10 codes documented on the encounter. For medical groups to excel at HCC coding, two important things must happen.

First, the provider must document whether a patient’s chronic conditions impacted the encounter—and if so, how. Second, the coder must ensure that the ICD-10 codes on the claim accurately and completely represent what is in the clinical note—because payers use the underlying ICD-10 codes submitted on claims to calculate the HCC scores, which in turn determine your reimbursements.

REMEMBER: Every inaccurate or insufficiently specific diagnosis code on a claim reduces your patient’s risk adjustment (RAF) score and your ability to collect appropriate reimbursement in the future

How RCxRules can help

RCxRules’ HCC solution contains the complete set of CMS Diagnosis coding rules and the full mapping of ICD-10 codes to the Hierarchical Condition Categories.

Our solution  sits between your clinical system and your revenue cycle management (RCM) system, automating the review of every encounter that leaves your EMR in real time. This ensures that clinical encounters have the appropriate and specific diagnosis codes necessary to derive an accurate HCC score.


Think of it. A world without denials

Is it possible? We believe it is. And at RCxRules, we’re helping our customers move closer to it every day by delivering:

  • The healthcare industry’s cleanest, most reliable business office data—every time, guaranteed .
  • Automated review of 100% of your charges against our robust, tailored rules—rules created specifically for your data issues and business challenges—before they hit your billing system.

The results? Unprecedented denial-reduction rates and more successful reimbursements—plus dramatic improvements in your business process efficiencies, staff productivity, employee morale, and more.

Here’s how we do it

  • Our comprehensive RCxRules engine moves the management of payer requirements from the back end (where it traditionally takes place) to an efficient, technology-enabled front-end process. We analyze denial patterns and build rules around your most important issues.
  • By combining the latest industry-standard rules (LCD, NCD, CCI, MUE) with unique, high-value rules tailored to your organization, RCxRules’ predictive rules engine automatically fixes your routine issues, eliminating the need for time-intensive manual review and correction.
  • Once your rules are written, they’re consistently, accurately, and automatically applied 100% of time, resulting in what we like to call “bulletproof claims-submission performance.”

To achieve this, we leverage a data-driven implementation methodology and advanced analytics to identify and focus on top issues impacting your revenue cycle performance. Rather than a large, vague collection of generic rules, this high-value rule set is custom-tailored to your unique specifications, maximizing the financial benefits for your organization.

The immediate financial impact includes significantly reduced denials, faster reimbursements, and rapid return on investment.


Get paid more often, more quickly, with less effort

Say goodbye to slow, tedious, time-consuming—and expensive—manual review of all charges coming out of your EMR.

RCxRules’ robust, intuitive software solutions sit at the front end of your revenue cycle process, automatically reviewing and correcting charges before they hit your revenue cycle management (RCM)system—eliminating the need for manually reviewing most charges that originate in the EMR.

And all of our solutions seamlessly integrate with your existing EMR and RCM systems, for fast implementation and smooth operation day after day, year after year.

By combining comprehensive industry-standard rules with tailored, high-value rules customized to your unique requirements, RCxRules significantly accelerates the process of submitting clean, payment-ready charges to your payers.

Faster charge processing and reduced denials translate to increased reimbursements and improved payment velocity—all with less rework, fewer claim resubmissions, and reduced manual effort.

With RCxRules, you get paid faster with less effort. It’s that simple, but the benefits to your revenue cycle are anything but.


RCxRules offers healthcare’s only predictive rules engine that integrates easily with your existing EMR and revenue cycle management system, delivering unprecedented automation, operational efficiency, and financial performance.

Learn more about RCxRules solutions.

“Clean, accurate financial data drives strong performance across our organization. With RCxRules, the processing of charges from our clinical systems is now highly automated. With more accurate data in our financial system, we have dramatically reduced denials and improved staff efficiency. This helps us continue to improve the level of service we provide to our physician customers, which is essential given today’s competition. I don’t see how we could produce these results without RCxRules.” 

Brian Hall
Physicians Resources Limited