Primary Care Revenue Cycle Automation
Primary care revenue cycle management involves high-volume E/M billing across acuity levels, preventive care coding complexity, chronic care management billing, and eligibility verification for diverse payer mixes. Sarva automates eligibility checks at booking and day-of, validates E/M level selection against documentation, and manages preventive care and chronic care management coding.
Specialty-Specific RCM Challenges
High-Volume E/M Billing
Primary care practices process high claim volumes with E/M codes across 5 levels. Accurate level selection is critical for revenue and compliance.
Preventive Care Coding
Preventive visits have different coding than problem-focused visits. Mixing the two on the same day requires careful coding.
Chronic Care Management
CCM and PCM codes require documented care coordination time. Missing documentation causes denials.
Diverse Payer Mix
Primary care sees patients with diverse insurance types — commercial, Medicare, Medicaid, marketplace. Each has different rules.
Authorization Issues
Most primary care services do not require prior authorization. However, certain procedures (minor in-office procedures, some injections) and referrals to specialists may require authorization. Sarva identifies these exceptions and handles them automatically.
Common Denial Categories
Workflow Example
A patient arrives for an annual wellness visit but also discusses a new acute problem. Sarva validates that both a preventive code and a problem-focused E/M code are supported by documentation, checks that modifier 25 is applied, and confirms eligibility for both service types before claim submission.
KPI Focus
See how Sarva handles your specialty's RCM challenges.
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Healthcare AI Automation
Frequently Asked Questions
Sarva validates that both a preventive code and a problem-focused E/M code are supported by the documentation, ensures modifier 25 is applied, and verifies that both service types are covered under the patient's plan before claim submission.
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