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Your Conversational, No-Fluff Guide to Medical RCM

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Medical RCM Payment Models Guide 2025 | Altrust Services

Your Conversational, No-Fluff Guide to Medical RCM

Real-world stories, strategic advice, and the shove of motivation you need to own your revenue cycle in 2025

Why This Page Matters (And Why I Wrote It)

I’ve spent the last decade elbow-deep in medical RCM projects—from scrappy rural clinics to sprawling IDNs. I’ve seen contracts that make CFOs grin and reimbursement nightmares that keep rev-ops teams up at 2 a.m. This guide distills those hard-won lessons into a narrative you can actually use.

If you’re tired of jargon that feels miles from your daily grind, breathe easy. We’re talking straight about payment models, reimbursement pathways, and how every decision you make today echoes through tomorrow’s revenue impact.

The Big Picture: Healthcare Payment Systems

Picture your revenue cycle as a highway system. Payers are the toll booths, clinical services are the cars, and you’re the traffic controller trying to keep cash flowing—all while dodging potholes made of denied claims. Whether you lean on traditional payment methods or shiny new alternative payment arrangements, the goal never changes: move money smoothly, ethically, and sustainably.

Fee-for-Service: Old Dog, Same Tricks

Fundamentals of Fee for Service Structures

I once coached a cardiology group that lived and died by FFS. Great for volume, terrible for sanity. Every CPT code was a lottery ticket—cash in hand if coded right, payer pushback if you missed a modifier.

  • Revenue impact: Predictable short term, growth-limited long term.
  • Cost containment: Low. More services = more revenue, period.
  • Pro move: Automate claim scrubbing. Manual audits are 1990s tech in a 2025 race.

Value-Based Care: Chasing Outcomes, Not Encounters

Exploring Value Based Care Initiatives

A primary-care network slashed readmissions by 18 % simply by texting post-discharge patients. That translated into a six-figure shared savings bonus.

  • Reimbursement pathways tie dollars to quality metrics.
  • Risk adjustment protects you when sicker populations skew averages.
  • Patient-reported outcomes move the bonus dial faster than any KPI I’ve seen.

Remember, VBC isn’t charity—it’s capitalism aligned with better health.

Capitation Plans: Fixed Cash, Variable Stress

Introductory Guide to Capitation Plans

Capitation pays you a prospective payment every month—money lands before services start. Sounds dreamy until flu season wipes out your margins.

Real-world tip: Load your cap roster weekly. One FTE missed on the list can leak five figures annually.

Escape Velocity: Transitioning from Traditional Payment Methods

Shifting from FFS to hybrid models is like swapping airplane engines mid-flight. Here’s the three-step turbulence plan I use:

  1. Contract inventory—document every rate, clause, and carve-out.
  2. Gap analysis—overlay predicted margins across multiple reimbursement approaches.
  3. Pilot a bundled episode—orthopedics is the low-hanging fruit.

Patient Engagement: Your Untapped Revenue Engine

Encouraging Patient Engagement in Financial Decisions

Patients who understand their bill pay faster—sometimes 30 % faster. Offer up-front cost estimates and SMS pay links. You’ll cut bad-debt write-offs and boost goodwill. Win-win.

Bundled Payments: One Price to Rule the Episode

Understanding Bundled Payments in Clinical Services

Surgery, rehab, follow-ups—one invoice. Providers who master care coordination pocket the delta between target and actual spend. Blow the budget and you eat the loss. Harsh? Yep. Effective at trimming waste? Absolutely.

Risk Sharing Agreements & Shared Savings

Evaluating Risk Sharing Agreements with Payers

Think of risk sharing agreements as poker with actuaries. One-sided risk? You only win. Two-sided? You can lose your shirt—add a stop-loss clause.

The Role of Shared Savings in Cost Containment

Shared savings programs bankroll your population-health dreams when you hit cost targets.

Alternative Payment Arrangements: The Wild West of Revenue

Direct-to-employer deals, subscription care, micro-capitation—creative payment models that can skyrocket margin if you master contract-level analytics. Ignore them and you’ll watch competitors siphon your healthiest patients.

Prospective Payment: Paid Up-Front, Paid to Sweat

Pros and Cons of Prospective Payment Strategies

Pros: Cash today, simplified billing.
Cons: You’re the insurer if costs explode. Hedge with reinsurance or carve-outs for high-cost meds.

Managing Multiple Reimbursement Approaches

  • Centralized contract library—searchable and version-controlled.
  • Rules-based billing engine—auto-switch logic by payer.
  • Unified analytics layer—one dashboard to rule gross vs. net.
  • Cross-functional governance—finance + clinical + IT in the same war room.

This playbook saved my last client from a seven-figure underpayment audit.

Action Plan: Next-Week Wins

DayWhat to DoWhy It Matters
MondayPull 90-day revenue by payment modelSpot margin drains fast
WednesdayFlag top 3 FFS codes with highest denial ratesPlug leaks first
FridaySchedule payer meeting to discuss a bundled payments pilotLow-risk toe-dip into VBC
Next WeekLaunch cost-estimate tool in the patient portalBoost engagement & collect cash sooner

Final Pep Talk: One smart contract can out-earn a dozen mediocre ones. Make financial decisions that protect patients, empower clinicians, and strengthen your bottom line. — Altrust Services

Why AltruST is Your Ideal Offshoring Partner?

Looking to elevate your team with top-tier talent? Meet Altrust – your go-to offshoring ally for businesses of all sizes.   

At Altrust, we’re all about crafting teams that vibe with your culture and values. Our commitment to quality and professionalism makes us the perfect fit for businesses seeking offshoring excellence.   

With a proven track record, our seasoned professionals are here to guide you through the offshoring journey, ensuring a seamless and successful partnership.   

Partnering with Altrust means tapping into our expertise in cultural alignment, talent acquisition, and employee management. We’re not just a service; we’re your dedicated partner in building the perfect global team for your business – whether you’re a small startup or a big player in the market.   

To reach out to Altrust please contact us at buildmyteam@altrustservices.com. Let’s discuss how we can enhance your team with top-tier talent and explore the benefits of offshoring excellence together. Looking forward to connecting! 

Boost Your Team. Build Your Future. Consult with Us!

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Your Conversational, No-Fluff Guide to Medical RCM

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MEDICAL AND DENTAL VIRTUAL ASSISTANT
40 hrs/week

Approx. Price Per Hour (USD): $10.00

 

Responsibilities may include:

•Booking and managing patient appointments.
•Coordinating meetings and maintaining calendars.
•Managing social media accounts.
•Creating and distributing newsletters.
•Running digital marketing campaigns.
•Handling patient inquiries.
•Managing patient follow-ups.
•Sending appointment reminders.
•Transcribing medical notes.
•Maintaining electronic health records (EHR).
•Ensuring proper documentation and coding.
•Assisting with recruitment and onboarding.
•Managing employee records.
•Coordinating training and development programs.
•Organizing and maintaining patient records.
•Managing data entry tasks.
•Ensuring compliance with data protection regulations (e.g., HIPAA).
•Providing IT support for office systems.
•Managing software and hardware issues.
•Ensuring cybersecurity measures are in place.
•Managing CRM systems.
•Conducting patient satisfaction surveys.
•Developing patient engagement strategies.
•Preparing financial statements.
•Managing accounts payable/receivable.
•Conducting financial analysis and reporting.
•Processing patient bills.
•Managing insurance claims.
•Handling payments and follow-ups on unpaid bills.
•Coordinating patient care transitions between healthcare settings.
•Ensuring continuity of care during transitions.
•Communicating care plans to patients and families.
•Monitoring and ordering medical supplies and equipment.
•Managing inventory levels.
•Coordinating with vendors for timely deliveries.


Requirements:
• Strong written English and communication skills
• Reliable and has a high attention to detail
• Proficiency with MS Office Tools and Google Docs
• Basic Excel proficiency
• Quick learner
• HIPAA Compliance

 

 

PATIENT COMMUNICATION SPECIALIST
40 hrs/week

Approx. Price Per Hour (USD): $10.00

 

Responsibilities:

  • Act as the primary point of contact for patients
  • Address inquiries, schedule appointments, and provide healthcare information
  • Handle patient complaints and concerns with empathy
  • Manage incoming and outgoing communications via phone, email, and messaging platforms
  • Maintain clear, professional, and timely communication with patients and stakeholders
  • Schedule, reschedule, and confirm patient appointments
  • Coordinate with medical staff for smooth appointment flow and minimal wait times
  • Update and maintain accurate patient records in the healthcare management system
  • Document patient interactions for reference and compliance
  • Conduct follow-up calls or messages for treatment plan and post-appointment care instructions
  • Remind patients of upcoming appointments and necessary preparations
  • Provide educational materials and resources about health conditions and treatments
  • Assist patients in understanding healthcare instructions and terminology
  • Work with healthcare providers, administrative staff, and team members to improve patient satisfaction and care outcomes
  • Participate in team meetings and training sessions
  • Handle sensitive patient information in compliance with HIPAA and regulatory requirements
  • Maintain confidentiality and security of patient data

Requirements:

  • High school diploma or equivalent required
  • Associate's or Bachelor's degree in healthcare administration, communications, or a related field preferred
  • Previous experience in a healthcare setting, particularly in patient communication or customer service roles
  • Familiarity with medical terminology and healthcare procedures
  • Excellent verbal and written communication skills
  • Strong interpersonal skills with the ability to empathize and connect with patients
  • Proficiency in healthcare management software, electronic health records (EHR), and relevant communication tools
  • Exceptional organizational skills with the ability to multitask and prioritize effectively
  • Attention to detail in managing patient information and scheduling
  • Strong problem-solving skills with the ability to think critically and make informed decisions
  • Ability to handle challenging situations calmly and professionally
  • Flexibility to adapt to changing schedules and patient needs
  • Willingness to learn and implement new technologies and procedures
  • Understanding of HIPAA regulations and commitment to maintaining patient confidentiality
  • Adherence to organizational policies and procedures
  • Bilingual or multilingual abilities are a plus, particularly in languages commonly spoken by the patient population
  • High level of professionalism and dedication to providing quality patient care
  • Strong work ethic and a positive attitude

DATA ENRTY SPECIALIST
40 hrs/week

Approx. Price Per Hour (USD): $8.00

 

Responsibilities:

  • Inputting data accurately and efficiently into databases and spreadsheets
  • Verifying data by comparing it to source documents
  • Updating and maintaining data systems and records
  • Preparing data for entry by compiling and sorting information
  • Reviewing data for errors, missing information, and inconsistencies
  • Communicating with team members to resolve data discrepancies
  • Ensuring data confidentiality and security
  • Performing regular backups to ensure data preservation
  • Generating reports and performing data retrieval as needed
  • Assisting with data-related tasks and projects as required

Requirements:

  • High school diploma or equivalent; additional computer training or certification is a plus
  • Proven data entry work experience, preferably in a similar role
  • Proficiency in using data entry software, databases, and MS Office applications
  • Excellent typing speed and accuracy
  • Strong attention to detail and organizational skills
  • Ability to handle confidential information responsibly
  • Good communication skills for collaborating with team members
  • Ability to work independently with minimal supervision
  • Basic understanding of data management principles
  • Strong time management skills with the ability to meet deadlines

MEDICAL TRANSCRIPTIONIST
40 hrs/week

Approx. Price Per Hour (USD): $10.00

 

Responsibilities:

  • Transcribe dictated recordings from healthcare professionals into written reports
  • Review and edit transcriptions for accuracy, grammar, and clarity
  • Ensure proper formatting and adherence to healthcare documentation standards
  • Identify and clarify inconsistencies or inaccuracies in medical dictations
  • Enter transcribed reports into electronic health records (EHR) systems
  • Maintain confidentiality and security of patient information in compliance with HIPAA regulations
  • Collaborate with healthcare providers to resolve any discrepancies in the transcriptions
  • Stay updated with medical terminology, procedures, and transcription practices
  • Perform quality assurance checks on transcriptions for completeness and accuracy
  • Follow up with healthcare professionals to obtain additional information or clarification as needed

Requirements:

  • High school diploma or equivalent required
  • Certification in medical transcription from an accredited program preferred
  • Previous experience as a medical transcriptionist or in a related role
  • Proficiency in medical terminology, anatomy, and pharmacology
  • Excellent typing speed and accuracy
  • Strong listening skills and attention to detail
  • Proficiency in using transcription software and EHR systems
  • Ability to work independently and meet deadlines
  • Understanding of HIPAA regulations and commitment to maintaining patient confidentiality
  • Strong written and verbal communication skills
  • Ability to adapt to different accents and dictation styles from healthcare providers

HUMAN RESOURCE ASSISTANT
40 hrs/week

Approx. Price Per Hour (USD): $8.00

 

Responsibilities:

  • Assist with day-to-day operations of the HR functions and duties
  • Provide clerical and administrative support to Human Resources executives
  • Compile and update employee records (hard and soft copies)
  • Process documentation and prepare reports relating to personnel activities (staffing, recruitment, training, grievances, performance evaluations, etc.)
  • Coordinate HR projects (meetings, training, surveys, etc.) and take minutes
  • Deal with employee requests regarding human resources issues, rules, and regulations
  • Assist in payroll preparation by providing relevant data (absences, bonus, leaves, etc.)
  • Communicate with public services when necessary
  • Properly handle complaints and grievance procedures
  • Conduct initial orientation to newly hired employees
  • Assist with recruitment by posting job ads, organizing resumes and job applications, scheduling job interviews, and assisting in interview processes
  • Coordinate communication with candidates and schedule interviews
  • Assist in various HR-related activities such as onboarding, training and development, and employee engagement

Requirements:

  • Proven experience as an HR Assistant, Staff Assistant, or relevant human resources/administrative position
  • Fast computer typing skills (MS Office, in particular)
  • Hands-on experience with an HRIS or HRMS
  • Basic knowledge of labor laws
  • Excellent organizational skills
  • Strong communications skills
  • Degree in Human Resources or related field preferred
  • Ability to handle data with confidentiality
  • Good understanding of HR practices and procedures
  • Multitasking and time-management skills, with the ability to prioritize tasks
  • Customer-focused attitude, with high level of professionalism and discretion
  • Bilingual or multilingual abilities are a plus

MARKETING AND PATIENT ACQUISITION SPECIALIST
40 hrs/week

Approx. Price Per Hour (USD): $10.00

 

Responsibilities:

  • Create and implement comprehensive marketing plans to attract and retain patients
  • Develop and execute targeted campaigns across various channels (social media, email, print, etc.)
  • Produce engaging content for marketing materials, including blogs, newsletters, social media posts, and website copy
  • Collaborate with the design team to develop visually appealing promotional materials
  • Identify and pursue opportunities to attract new patients
  • Develop partnerships with community organizations, businesses, and other healthcare providers
  • Conduct market research to identify patient needs and preferences
  • Analyze competitor strategies and market trends to inform marketing efforts
  • Plan and manage community events, health fairs, and open houses to promote services
  • Coordinate participation in local and industry events to increase brand visibility
  • Manage and optimize online presence, including website, social media profiles, and online directories
  • Implement SEO and SEM strategies to improve online visibility and attract new patients
  • Develop and maintain strong relationships with existing patients to encourage referrals and repeat visits
  • Implement patient retention programs and loyalty initiatives
  • Track and analyze marketing campaign performance
  • Provide regular reports on patient acquisition metrics and marketing ROI
  • Work closely with clinical and administrative teams to ensure alignment of marketing strategies with organizational goals
  • Collaborate with external vendors and agencies as needed

Requirements:

  • Bachelor’s degree in marketing, communications, healthcare administration, or a related field required
  • Previous experience in healthcare marketing or patient acquisition preferred
  • Proven track record of successful marketing campaigns and patient acquisition strategies
  • Strong written and verbal communication skills
  • Proficiency in digital marketing tools and platforms (e.g., Google Analytics, social media management tools)
  • Excellent organizational and project management skills
  • Ability to develop innovative marketing ideas and campaigns
  • Strong visual and content creation skills
  • Strong analytical skills to assess marketing performance and make data-driven decisions
  • Ability to interpret market research and patient data
  • Familiarity with CRM software and patient management systems
  • Proficiency in Microsoft Office Suite and design software (e.g., Adobe Creative Suite)
  • Ability to build and maintain relationships with patients, staff, and community partners
  • Strong team collaboration skills
  • Flexibility to adapt to changing market conditions and organizational needs
  • Willingness to learn and implement new marketing technologies and strategies
  • High level of professionalism and dedication to patient care
  • Strong work ethic and a positive attitude
  • Understanding of healthcare regulations and compliance standards related to marketing
  • Commitment to maintaining patient confidentiality and ethical marketing practices

CUSTOMER SUPPORT

40 hrs/week
Approx. Price Per Hour (USD): $10.00

 

Provides phone, video call, email, ticketing and online chat support to customer enquiries.

Example responsibilities may include:
• Answering phone, online chat enquiries and questions from new and existing customers
• Responding to customer emails
• Looking up customer order details from our internal CRM
• Processing refunds and other customer requests according to internal procedures
• Send email and SMS quotes to customers

Requirements
• Strong written English and verbal communication skills
• Attention to detail

BOOKKEEPER

40 hrs/week
Approx. Price Per Hour (USD): $10.00

 

Responsibilities and Tasks May Include:

  • Accurately record daily financial transactions and complete the posting process.
  • Generate, send, and follow up on invoices.
  • Reconcile financial discrepancies by collecting and analyzing account information.
  • Maintain a systematic record of financial documents and ensure they are up-to-date.
  • Process accounts receivable/payable and handle payroll efficiently.
  • Prepare monthly, quarterly, and annual financial statements.
  • Collaborate with the accounting team to prepare for audits and other financial reviews.
  • Stay updated with financial policies, regulations, and legislation.

Requirements

  • Proven bookkeeping experience with a strong attention to detail.
  • Proficiency in MS Excel and accounting software (e.g., QuickBooks, Xero).
  • Strong mathematical and analytical skills.
  • Ability to handle sensitive and confidential information with discretion.
  • Knowledge of generally accepted accounting principles and procedures.

Highly Regarded Skills and Experience

  • Experience in bookkeeping for international clients.
  • Familiarity with multiple accounting software platforms.
  • A degree or certification in Finance, Accounting, or a related field.
  • Strong interpersonal skills and the ability to work in a team environment.
  • Experience in managing financial records for small to medium-sized businesses.

WEB DEVELOPER

40 hrs/week
Approx. Price Per Hour (USD): $11.00

 

Responsibilities for a Developer Specialising in WordPress

  • Develop and maintain dynamic websites and web applications using WordPress.
  • Collaborate with the design and marketing teams to turn visions into reality.
  • Ensure high-performance and availability, managing all technical aspects of the CMS.
  • Establish and guide the website’s architecture.
  • Ensure high-quality source code, testing, and debugging.
  • Collaborate with front-end developers and web designers to improve usability.
  • Stay updated with the latest industry trends and advancements.

 

Requirements

  • Proven work experience as a WordPress Developer.
  • Good understanding of front-end technologies, including HTML5, CSS3, JavaScript, jQuery.
  • Experience building user interfaces for websites and/or web applications.
  • Proficient understanding of code versioning tools.
  • Strong understanding of PHP back-end development.
  • Familiarity with Google Tools such as Analytics and Search Console.
  • Knowledge of how to interact with RESTful APIs and formats (JSON, XML).
  • Excellent written and verbal communication skills.
  • Basic graphic design skills to create social media and website content.
  • Proficient in MS Office suite, including Excel and Outlook.
  • High school diploma or equivalent; associate or bachelor’s degree in business, marketing, or a related field preferred.

SEO SPECIALIST

40 hrs/week
Approx. Price Per Hour (USD): $10.00

 

Responsibilities

  • Perform comprehensive client SEO audits focusing on on-page, technical, off-page, and content aspects.
  • Conduct keyword research to identify target keywords and phrases.
  • Develop and implement on-page, off-page, technical, and content optimizations.
  • Create regular SEO reports highlighting organic performance, including keyword tracking, conversions, and organic traffic.
  • Develop and execute off-page SEO through link building
  • Develop and execute a content strategy to grow organic traffic.
  • Conduct competitor SEO analysis to incorporate into the SEO strategy.
  • Collaborate with content writers and marketing teams to ensure SEO best practices are followed.
  • Stay updated with the latest industry trends, algorithm updates, and best practices.

 

Requirements

  • Proficiency in Google Analytics, including GA4.
  • Proficiency in Google Search Console.
  • Proficiency in SEO tools such as SEMRush, Ahrefs, Screaming Frog, and Botify.
  • Minimum of 3 years of experience in SEO, preferably in an agency setting.
  • Strong understanding of HTML/CSS and website structures.
  • Excellent written and verbal communication skills.

COLD CALLER

40 hrs/week
Approx. Price Per Hour (USD): $10.00

Responsibilities
  • Cold call real estate sellers from provided lead lists
  • Qualify sellers and properties over the phone
  • Schedule appointments for the acquisition team to visit potential investment properties
  • Log all calls and appointment details in the CRM (Folio)
  • Achieve daily and weekly appointment-setting targets

     

Scope
  • The cold caller will be provided leads to call and will need to learn the client’s specific process for qualifying sellers and properties.
  • They will use an internal CRM to log calls and appointments.
  • They will report directly to the client and work independently once trained on the process.

 

Requirements

  • 6 months experience in cold calling and/or appointment setting
  • Real estate and/or sales experience preferred
  • Clear phone voice and strong communication skills
  • Motivated self-starter who can work independently
  • Organized and detail-oriented
  • Familiarity with CRMs

MEDICAL BILLER AND CODER

40 hrs/week
Approx. Price Per Hour (USD): $10.00

Responsibilities
  • Obtain authorizations and pre-approvals from insurance companies
  • Verify patient insurance coverage
  • Submit claims to insurance companies
  • Follow up on unpaid/denied claims
  • Appeal denied claims
  • Communicate with insurance companies to resolve issues
  • Maintain accurate patient records
Requirements
  • 6 months experience in medical billing
  • Knowledge of billing practices, terminology, and software
  • Strong attention to detail and organization skills
  • Excellent written and verbal communication abilities
  • Able to multitask and prioritize effectively
  • Passion for improving the patient and provider experience

MEDICAL RECEPTIONIST

40 hrs/week
Approx. Price Per Hour (USD): $10.00

Responsibilities

  • Calendar and Task Management
  • Answer incoming phone calls
  • Schedule appointments for new and existing patients
  • Enter patient information into EMR system
  • Follow up on missed calls
  • Make reminder calls/texts for appointments

Requirements

  • At least 6 months experience as a Medical Receptionist
  • Familiarity with medical terminology and health insurance
  • Excellent phone skills and customer service skills
  • Strong attention to detail
  • Proficient with computers and data entry

DIGITAL MARKETING

Boost Your Medical Practice with Expert Digital Marketing

Enhance your online presence with our comprehensive Medical Digital Marketing package, designed to attract more patients and maximize your ROI. Our services include:

✅ Web Design & Development – Build a professional, high-converting website.
✅ Maintenance & Security – Keep your site updated, virus-free, and running smoothly.
✅ SEO (Basic & Expansion) – Improve search rankings and increase visibility.
✅ Google Business Profile Management – Stand out in local search results.
✅ PPC Management – Get high-quality leads with targeted ads.
✅ Social Media Marketing – Engage with patients and grow your brand.
✅ Email/SMS Marketing – Connect with your audience effectively.
✅ Press Release – Build credibility and brand awareness.

 

💡 Drive More Patients to Your Practice! See Our Affordable Plans Now:

 

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