6,500+ specialty providers
Visit-ready
Keep authorization and coverage aligned before the appointment is booked.
Hospital Outpatient PM & RCM Software
Hospital Outpatient Practice Management and RCM Billing, Built to Perform
Navigate OPPS, APC grouping, hospital/professional fee splits, and outpatient code editor compliance. See why hospital outpatient practices choose Unlimited Systems for practice management and RCM software.
Why Hospital Outpatient billing is different
Hospital outpatient departments operate under the Outpatient Prospective Payment System, where reimbursement is grouped into Ambulatory Payment Classifications and every claim must pass through the Outpatient Code Editor's hundreds of edits before it can be paid. The complexity of packaging, status indicators, and the dual hospital-facility and professional-fee billing structure means even minor coding inconsistencies cascade into widespread claim rejections. Unlimited Systems is purpose-built to navigate OPPS grouping logic and OCE compliance at scale across high-volume hospital outpatient service lines.
Every outpatient encounter at a hospital, whether an infusion, imaging study, minor procedure, or clinic visit, must be coded with HCPCS/CPT codes that map to status indicators determining whether the service is separately payable, packaged into another service's APC payment, or not payable under OPPS at all. The Outpatient Code Editor applies hundreds of automated edits checking code validity, medical necessity via coverage policies, units of service limits, and code combination rules, rejecting or returning claims that fail any edit before they reach the payer's adjudication system.
6,500+ specialty providersSOC 2 certified
Trusted Payer & EHR Integration Partners
Designed Around How Your Hospital Outpatient Practice ACTUALLY Works
Our connected workflows are built to make you and your work easier to do and increase your revenue.
Claim-ready
Validate hospital outpatient codes, modifiers, and documentation before submission.
Practice-ready
Give teams one view of denials, margin, and A/R priorities.
AI & Automation for Hospital Outpatient
Routine hospital outpatient work clears itself. Your team sees only what needs their judgment.
- Eligibility checks, claim status polling, and remittance posting run without a person driving them.
- Charges and authorizations are checked against Hospital Outpatient payer rules as they move.
- Worklists rank themselves by dollars at stake and filing deadline.
- Each flagged claim arrives with its likely cause and the documentation needed to resolve it.
Hear It From Our Clients
Specialty practices describe, in their own words, what changed after moving to Unlimited Systems.
Video testimonial
Dunmore, Pennsylvania
“As I look back at the transition, the support and the collaboration with the folks at Unlimited really helped make us feel at ease. We had a partner that really wanted us to be successful.”
- CEO
- Days in A/R shrank from 21 to 15, consistently.
- Charges go out the next day.
- Less manual work, more clean claims, and stronger cash flow.
Calculate Your RCM Revenue Leakage
Drag the sliders to estimate how much unrealized cash remains locked in your current specialty billing cycles before optimization.
Model your current claim volume
Adjust both inputs to match your practice.
1,500
200 claims15,000 claims
$250
$80 value$3,500 value
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See Your Results ImmediatelyGoogle5/5Gartner5/5G24.8/5
One platform for every hospital outpatient workflow
Every hospital outpatient capability, grouped around the way your practice works.
Front office
Register, schedule and clear patients before the visit.
Billing & claims
Turn documented care into clean claims and work denials.
Payments & AR
Post payments, collect patient balances and work open AR.
Analytics & value-based care
Measure performance, report it and manage quality programs.
Platform & AI
Automation, workflow, integration and the platform underneath.
Don't Love Your Current Software Provider?
That's putting it nicely based on what we hear every day.
A support line that never picks up. An overseas call center that's never heard of your account. Errors nobody catches until the denial shows up. We're Midwest-based, not offshore, and the team that answers already knows your account. Practices that switch tend to wish they'd done it sooner.
- Located in Cincinnati, Ohio — no offshore call centers
- Founded by healthcare leaders, not tech-bros
- Industry leaders in innovation, technology, and automation
“I would recommend Unlimited Financials to other specialty practices.”
Michelle LeandriCEO, NEPA
“We transitioned to Unlimited Financials in 2024... the team and platform are absolutely amazing.”
GinaAdministrator, FOUR
“We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.”
Renee BernacchiAccounts Receivable Coordinator, COAS
The Hospital Outpatient suite
Take a guided tourEvery part of the hospital outpatient revenue cycle, in one system
Each module is configured for the codes, modifiers, and payer rules hospital outpatient teams work with, not adapted from generic billing software.
Hospital Outpatient Patient Intake SoftwareVerify outpatient benefit coverage and medical necessity policy requirements for the scheduled service before the visit.Hospital Outpatient Patient Scheduling SoftwareCoordinate scheduling across imaging, infusion, surgery, and clinic departments within the outpatient facility.Hospital Outpatient Financial Clearance SoftwareCheck services against payer coverage policies and generate Advance Beneficiary Notices when medical necessity isn't established.Hospital Outpatient Charge Validation SoftwareRun charges through a comprehensive Outpatient Code Editor simulation before submission to catch edit failures proactively.Hospital Outpatient Payment Posting SoftwarePost remittances and reconcile actual APC payments against expected grouping and packaging logic.Hospital Outpatient AR Management SoftwareTriage and correct OCE-rejected claims by edit type before resubmission to minimize turnaround delays.Hospital Outpatient Analytics SoftwareTrack service volume, APC distribution, and revenue performance across outpatient departments and service lines.Hospital Outpatient Value-Based Care SoftwareMonitor compliance with hospital outpatient quality reporting program measures to maintain full payment rates.
The cost of generic billing
You went into hospital outpatient to treat patients, not to chase claims
These are the places hospital outpatient practices most often lose revenue when their billing platform wasn’t built for the work. Unlimited Systems closes each one with rules configured for your specialty.
Review your workflowCommon hospital outpatient revenue leaks
- Claims rejected at the OCE stage before ever reaching the payer due to invalid code combinations, units, or status indicator conflicts.
- Packaged services billed separately when payment status indicators dictate they should be bundled into the primary APC payment.
- Hospital facility-side and physician professional-side claims for the same encounter creating coordination and timing conflicts.
- Multiple procedures within the same APC family requiring correct discounting under OPPS multiple procedure payment reduction rules.
Challenges we solve for hospital outpatient
The work that generic platforms leave to your staff is the work hospital outpatient margin actually turns on.
OCE Edit Compliance
Built-in OCE simulation catches edit failures before submission, dramatically reducing rejection-driven rework cycles.
APC Packaging Logic
Status indicator-aware charge engine automatically packages bundled services into the correct primary APC claim line.
Hospital/Professional Fee Coordination
Coordinated dual-claim workflow ensures facility and professional claims align on coding and timing for the same encounter.
Legacy software vs. Unlimited Systems
See why hospital outpatient practices move off general-purpose billing platforms.
CRITERIA
LEGACY SYSTEM COMPROMISE
UNLIMITED SYSTEMS VALUE
OCE Edit Compliance
✕Claims are submitted without pre-checking against OCE edit logic, resulting in widespread rejections and rework.
✓Built-in OCE simulation catches edit failures before submission, dramatically reducing rejection-driven rework cycles.
APC Packaging Logic
✕Services with 'packaged' status indicators are billed separately, creating denial patterns and compliance risk.
✓Status indicator-aware charge engine automatically packages bundled services into the correct primary APC claim line.
Hospital/Professional Fee Coordination
✕Facility and professional claims for the same encounter are submitted independently with timing and coding mismatches.
✓Coordinated dual-claim workflow ensures facility and professional claims align on coding and timing for the same encounter.
Still evaluating
Not Ready to Switch Yet? That's Exactly When to Start the Conversation.
You don't have to be actively replacing your current system to have a useful conversation with Unlimited Systems. Many specialty practices talk with us months before a contract renewal, system evaluation, or operational change so they can understand where revenue leakage, denial risk, prior authorization delays, and reporting gaps may already be showing up.
You don't have to wait until your contract is up to start evaluating your options. The best time to assess your revenue cycle technology is before renewal pressure begins. Unlimited Systems can help you understand where your current workflows may be creating avoidable denials, manual work, charge capture gaps, or reporting limitations, so you're better prepared for renewal, replacement, or future planning.
That concern is valid, specialty practice operations are too important to disrupt. A conversation with Unlimited Systems doesn't mean an immediate rip-and-replace. We help teams evaluate workflows, identify gaps, and build a realistic path forward based on specialty, volume, payer mix, locations, integrations, and internal readiness.
Most specialty teams are already stretched thin. That's why the evaluation should focus on where the largest operational burden exists today, prior authorization, denials, charge capture, reporting, manual reconciliation, or payer-specific follow-up. The goal isn't to add work. It's to understand where better systems can remove it.
“Good enough” can still hide revenue leakage. Many practices aren't losing revenue because claims aren't being submitted, they're losing it through preventable denials, underpayments, missed modifiers, incomplete documentation, delayed authorizations, manual workarounds, and limited visibility into payer performance.
Unlimited Systems isn't designed to replace the expertise of your billing team. It's designed to give them better tools, cleaner workflows, better visibility, and fewer manual workarounds. Strong teams still need technology that helps them prioritize the right work, catch issues earlier, and reduce preventable rework.
Cash flow continuity is one of the biggest reasons to evaluate carefully and early. Unlimited Systems can help practices understand potential risk areas before a transition plan is ever built, including claim flow, authorizations, charge capture, payer rules, reporting, and operational dependencies.
Change management matters. The right platform should simplify daily work, not create unnecessary complexity. Unlimited Systems focuses on specialty workflows that align with how teams already manage authorizations, charges, denials, documentation, and financial follow-up.
Reporting is often the first visible symptom of a deeper workflow issue. If leadership can't clearly see denial trends, underpayments, authorization delays, payer behavior, or staff workload, it's harder to know what to fix. Unlimited Systems combines workflow tools with Power BI analytics to help leaders see where performance is improving and where revenue is still at risk.
That's a smart approach. A conversation with Unlimited Systems can help identify the financial case before a buying decision. Common areas to evaluate include denial reduction, staff efficiency, underpayment detection, charge capture improvement, prior authorization turnaround, and reduced manual reconciliation.
Specialty practices often depend on EHRs, clearinghouses, payment tools, drug workflows, and reporting systems. Unlimited Systems is designed to act as a connected financial workflow layer that helps reduce fragmentation, not add more disconnected work.
That caution is healthy. Automation should make decisions easier to see, not harder. Unlimited Systems is designed to surface why a claim is flagged, which payer rule applies, and where a human should step in, so your team stays in control while routine work is handled for them.
You don't need to be ready to buy to have a useful conversation. Many practices start by comparing their current workflows against what specialty-specific revenue cycle technology can support. That gives leadership a clearer view of what to fix now, what to plan for, and what questions to ask before the next renewal.
Less billing work between the visit and payment
Specialty rules and connected data keep your team focused on the exceptions that need judgment.
Verify before the visit
Coverage and authorization stay tied to the order.
Validate specialty charges
Code, unit, and modifier checks happen before filing.
Work the right accounts
Denials and A/R are ranked by value and filing risk.
35%less manual workflow time
One platform
The rest of the platform your hospital outpatient practice runs on
The same connected system handles the operational work that sits either side of billing.
Patient Intake
Digital intake, eligibility, and demographic capture before the visit.
Explore Patient IntakePatient Scheduling
Smart calendars and resource scheduling across providers and locations.
Explore Patient SchedulingFinancial Clearance
Automated eligibility checks and prior authorization management.
Explore Financial ClearanceCharge Validation
Pre-claim scrubbing for coding, modifiers, and compliance accuracy.
Explore Charge ValidationBuilt for hospital outpatient
Follow one hospital outpatient patient from intake to payment
Eight stages, one record. Nothing is rekeyed between systems, so a detail captured at the front desk is still there when the claim goes out, and when the remittance comes back.
Walk the workflow with us- 1Patient Intake for hospital outpatientDigital intake and demographic capture built around hospital outpatient visit types.
- 2Patient Scheduling for hospital outpatientCalendars and resources that reflect how hospital outpatient appointments actually run.
- 3Financial Clearance for hospital outpatientEligibility and prior authorization resolved before the patient arrives.
- 4Charge Validation for hospital outpatientSpecialty scrubbing on codes and modifiers before the claim leaves the building.
- 5Payment Posting for hospital outpatientERA and EOB posting reconciled automatically against what was billed.
- 6AR Management for hospital outpatientWorklists ranked by dollar value, aging, and timely-filing deadline.
- 7Healthcare Analytics for hospital outpatientLive visibility into denials, yield, and performance by provider and procedure.
- 8Value-Based Care for hospital outpatientQuality measures and episode costs tracked under alternative payment models.
Part of Multi-Specialty
Hospital Outpatient within Multi-Specialty
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Oral & Maxillofacial Surgery RCM SoftwareBilling and practice management for oral & maxillofacial surgeryFrequently asked questions
Our charge engine runs each claim through an OCE simulation that checks code validity, age and gender conflicts, units of service limits, code combination edits, and medical necessity coverage requirements, flagging and correcting issues before the claim ever leaves the building, dramatically reducing post-submission rejections.
Each HCPCS/CPT code on the claim is mapped to its assigned APC and status indicator under the current OPPS rules, and our system groups services accordingly, applying packaging logic for status indicator 'N' (packaged) services and ensuring separately payable services (status indicator 'S', 'T', 'V', etc.) are billed correctly.
Services with packaged status indicators (such as most drugs, supplies, and ancillary services tied to a primary procedure) are automatically incorporated into the payment for the primary APC and are not billed as separate payable line items, though they remain on the claim for informational purposes as required.
When multiple procedures with status indicator 'T' (significant procedure, multiple procedure reduction applies) occur in the same encounter, our system applies the OPPS multiple procedure payment reduction (typically 50% for additional procedures) to the appropriate claim lines automatically.
We maintain linked records for the hospital facility claim (UB-04, OPPS/APC-based) and the physician professional claim (CMS-1500, fee-schedule-based) for the same encounter, ensuring consistent coding of the underlying service while applying the correct billing methodology and place-of-service for each claim type.
Yes. When a scheduled outpatient service doesn't meet a payer's medical necessity coverage policy based on the documented diagnosis, our system flags the encounter for an ABN to be presented to the patient before the service is rendered, protecting the facility's ability to bill the patient if Medicare denies the claim.
Infusion and injection administration codes are sequenced correctly (initial, sequential, concurrent) per CPT hierarchy rules, with associated drug HCPCS codes packaged or separately payable based on their OPPS status indicator, and JW/JZ modifier waste billing applied per current Medicare requirements.
We track the clinical data elements required for Hospital Outpatient Quality Reporting measures throughout the encounter and generate the structured submissions needed to avoid the payment reduction penalty applied to facilities that don't meet reporting requirements.
New to revenue cycle terminology? Browse our healthcare RCM & billing glossary.
We Love Hearing From Our Users
Practices like yours, on what changed after moving to Unlimited Financials.
“
Rated 5 out of 5
The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.
Ernelita Dacumos
Billing Manager, SHOM
“
Rated 5 out of 5
Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.
Melissa Shook
Medical Biller, SHOM
“
Rated 5 out of 5
We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.
Renee Bernacchi
Accounts Receivable Coordinator, COAS
“
Rated 5 out of 5
Unlimited Financials has allowed us to extend our workforce in some areas due to the workflow efficiencies and given a better patient experience.
Mel Davies
CFO, Oregon Oncology Specialists
“
Rated 5 out of 5
Knowledge of the patient's coverage has been a game changer. The ability to verify benefits before the patient comes in has saved us on time and denials, so there is no delay in treatment.
Alisha Haslem
Patient Advocate Manager, Utah Cancer Specialists
“
Rated 5 out of 5
Using Unlimited Systems has allowed us to get a much better handle on our AR and claim management.
Erin Wilcher
Executive Director, Commonwealth Cancer Center
“
Rated 5 out of 5
The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.
Ernelita Dacumos
Billing Manager, SHOM
“
Rated 5 out of 5
Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.
Melissa Shook
Medical Biller, SHOM
“
Rated 5 out of 5
We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.
Renee Bernacchi
Accounts Receivable Coordinator, COAS
“
Rated 5 out of 5
Unlimited Financials has allowed us to extend our workforce in some areas due to the workflow efficiencies and given a better patient experience.
Mel Davies
CFO, Oregon Oncology Specialists
“
Rated 5 out of 5
Knowledge of the patient's coverage has been a game changer. The ability to verify benefits before the patient comes in has saved us on time and denials, so there is no delay in treatment.
Alisha Haslem
Patient Advocate Manager, Utah Cancer Specialists
“
Rated 5 out of 5
Using Unlimited Systems has allowed us to get a much better handle on our AR and claim management.
Erin Wilcher
Executive Director, Commonwealth Cancer Center
GET STARTED
Optimize Your Specialty Revenue Cycle
Connect with a specialized Hospital Outpatient RCM expert for a personal workflow walkthrough, and see where your current setup is creating avoidable revenue risk.
6,500+ specialty providersSOC 2 certified