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Full revenue cycle · Updated August 2026
The whole cycle, or the one stage that is leaking
Seven stages, each with its own failure mode. Most practices do not need all seven outsourced — they need the two that are quietly costing them six figures a year.
A behavioral health revenue cycle runs from eligibility and benefit verification through prior authorization, coding and charge entry, claim submission, denial management, accounts receivable follow-up and patient balances. Most preventable revenue loss originates in the first two stages, before a claim exists. Recura Health operates any single stage or the full cycle, priced at 4–8% of net collections.
One claim, end to end
Where a claim actually stops
The same journey every claim takes. Two nodes are where independent behavioural health practices lose six figures a year.
Where does the money actually leak?
Stage by stage, with the specific behavioral health failure mode rather than the generic one.
| Stage | The behavioral health failure mode | What we do |
|---|---|---|
| 1 · Eligibility & benefits | Behavioral health is carved out to a separate MBHO. The medical card does not say so. | Verify the carve-out and the delegate before intake, alongside deductible and copay position. |
| 2 · Prior authorization | Authorizations tracked by expiry date rather than remaining units. Sessions delivered past the unit balance are unbillable. | Unit-level tracking per client per code, with reauthorization triggered on balance, not calendar. |
| 3 · Coding & charge entry | Time-based units mis-derived from session notes; rendering provider mismatched to the code's supervision requirement. | Unit maths reconciled against documented start and stop times before the claim is built. |
| 4 · Claim submission | Clearinghouse rejections handled as a queue nobody owns, so they age silently. | Same-week rejection clearance, clean-claim rate reported weekly rather than monthly. |
| 5 · Denial management | Blind resubmission of denials whose root cause repeats. Roughly six in ten denied claims are never resubmitted at all. | Root cause by payer and by code, appeals written with clinical documentation attached, and the upstream fix applied. |
| 6 · AR follow-up | Payer calls placed outside US business hours, or not placed at all. | Aged AR worked oldest-first, calls during payer hours, notes documented against the claim. |
| 7 · Patient balances | Deductible-season balances left uncollected because staff are uncomfortable asking. | Statement cadence and payment plans handled off the practice's plate. |
What we report, and how often
A weekly scorecard, not a monthly invoice with a summary attached. These are the five numbers that tell you whether this is working.
First-pass acceptance rate
Share of claims accepted on first submission. Behavioral health benchmarks put a healthy clean-claim rate around 92–95%.
Denial rate by payer and code
Not one aggregate number — the breakdown, because the aggregate hides which payer is driving it.
Days in AR
Tracked with the aged buckets visible, so 90+ cannot be smoothed away by a good month of current claims.
Net collection rate
What you collected against what was collectible — the number that separates a billing problem from a contracting problem.
Dollars recovered from aged AR
Reported separately from current-period collections, so the recovery work is visible rather than blended in.
Authorization exposure
Units delivered against units approved, per client — the leading indicator nobody reports and everybody needs.
How the transition works
Thirty days, run in parallel. The single biggest risk in changing billing vendors is a gap where claims are nobody's responsibility — so we do not create one.
Audit and access
Read-only review first: denial patterns, aged AR, and a unit-level reconciliation of every active authorization. System access, BAA and named account lead in place.
Parallel run
We take over payer by payer while your existing process keeps operating. Nothing is cut over until the payer behind it is clean.
Full operation
Weekly scorecard from the first week, not the first quarter. Aged AR worked alongside current claims rather than written off at handover.
The weekly scorecard
You see it working, or you see that it is not
Five numbers every week — first-pass acceptance, denial rate by payer and code, days in AR, net collection rate, and dollars recovered from aged AR. Reported weekly, not monthly, because a month is long enough for a payer problem to compound.
The audit comes before the proposal
We will not quote a percentage before seeing your denial pattern, because a number quoted blind is a guess. Read-only access, five business days, one page back.