Company & Compliance Profile
A comprehensive overview of Revenue RCM LLC, our proprietary RevenuePro software, and the rigorous regulatory framework that governs every aspect of our revenue cycle management operations — designed for legal, compliance, and procurement teams evaluating us as a trusted RCM partner.
Compliance is not a checkbox — it is a culture
Revenue RCM LLC is a dedicated revenue cycle management company headquartered in Kalispell, Montana. We develop and operate RevenuePro, our proprietary RCM software platform, designed from the ground up to meet the complex billing, compliance, and data-security requirements of modern healthcare providers and payers.
Our team combines deep expertise in healthcare billing, regulatory compliance, and enterprise-grade information technology — delivering a solution that is both operationally powerful and rigorously secure. We serve healthcare organizations across the country with end-to-end revenue cycle management and an unwavering commitment to patient data protection.
Every workflow, system architecture decision, and staff training program is built around a single principle: protect patient data at every step of the billing lifecycle.
Our Product
RevenuePro — a secure, cloud-hosted, fully HIPAA-compliant RCM platform built for providers and payers who demand precision, transparency, and regulatory confidence.
Our Location
1001 S. Main St., STE [Suite/Room], Kalispell, MT 59901
Our Mission
To deliver best-in-class revenue cycle management through technology and compliance leadership — protecting patient data at every step of the billing lifecycle.
Proactively engineered into every layer
Revenue RCM LLC and RevenuePro strictly adhere to the privacy, security, and billing guidelines established by all applicable federal and state governing bodies. Our compliance program is not reactive — it is built into every layer of our operations and technology stack.
HIPAA & HITECH
The Health Insurance Portability and Accountability Act and HITECH Act form the foundation of our privacy and security architecture.
HHS, OIG & OCR
We align fully with HHS, the Office of Inspector General, and the Office for Civil Rights — including continuous audit-readiness protocols.
CMS & AMA
CMS billing guidelines and AMA ethical standards are embedded directly into our claim-processing workflows.
FTC, FCA & ADA
The FTC Health Breach Notification Rule, False Claims Act compliance via DOJ, and ADA accessibility standards are all addressed in our policies.
Ten federal agencies & statutes that govern our work
Compliance with each is mandatory, continuously monitored, and regularly audited by our internal compliance team.
The cornerstone federal law governing patient data privacy and security.
Sets guidelines for fraud prevention and healthcare billing integrity nationwide.
Primary federal authority over healthcare privacy regulation and enforcement.
Ensures our platform and privacy policies are accessible and inclusive for all patients.
Ethical guidelines for patient data handling and physician billing confidentiality.
Mandates billing standards for Medicare and Medicaid data privacy and security.
Enforces HIPAA privacy and security rules; we maintain full audit readiness at all times.
Strengthens HIPAA for electronic health records; fully incorporated into RevenuePro.
Health Breach Notification Rule extends breach obligations beyond HIPAA covered entities.
False Claims Act enforced via DOJ; our data integrity and coding protocols ensure full compliance.
Strict conformance with specific statutes
Our legal and compliance team maintains current interpretations of each statute and ensures RevenuePro is updated to reflect regulatory changes as they occur.
| Statute / Regulation | Description | Applicability |
|---|---|---|
| 42 U.S.C. § 1320d et seq. | The HIPAA Statute — establishes the foundational legal requirements for healthcare data privacy and security nationwide. | Core Platform |
| 45 CFR Parts 160, 162 & 164 | HIPAA Privacy, Security & Breach Notification Rules — the regulations governing day-to-day PHI handling, safeguards, and incident response. | All Operations |
| 42 U.S.C. § 17931 et seq. | HITECH Act provisions — strengthens privacy and security obligations for electronic PHI and increases penalties for violations. | RevenuePro Software |
| 31 U.S.C. §§ 3729–3733 | False Claims Act — prohibits submission of false or fraudulent claims to federal healthcare programs; enforced by DOJ. | Billing Integrity |
| 18 U.S.C. § 1347 | Health Care Fraud statute — criminalizes intentional deception or misrepresentation in healthcare billing and claims submissions. | Anti-Fraud Controls |
All statutory references are reviewed annually by our compliance counsel and updated within RevenuePro’s automated compliance engine to reflect current federal and state law interpretations.
Core Privacy & Compliance Standards
The first pillar addresses the foundational regulatory standards that govern all patient data privacy in revenue cycle management — non-negotiable operational baselines embedded throughout RevenuePro and our internal processes.
100% HIPAA Compliance
Our program encompasses the full scope of 45 CFR Part 164 — Privacy, Security, and Breach Notification Rules. Every RevenuePro workflow handles PHI in conformance, from intake through final remittance, with regular internal audits and gap analyses.
OIG Compliance & Fraud Prevention
OIG guidelines inform our billing integrity protocols, coding accuracy standards, and internal audits — including voluntary exclusion-list screening and a zero-tolerance policy for upcoding, unbundling, or fraudulent billing.
HHS & OCR Audit Readiness
We maintain continuous audit readiness for HHS and OCR investigations. Documentation, Notice of Privacy Practices, and incident response are structured to satisfy OCR requirements, validated by periodic mock audits.
State vs. Federal Privacy Coverage
Where state laws are stricter than federal standards under 45 CFR Part 160, we adopt the more stringent standard — backed by a continuously updated matrix of state-specific healthcare privacy laws.
RevenuePro Software Security
RevenuePro is engineered security-first. Every feature, integration point, and data pathway is designed to protect PHI and meet or exceed HIPAA Security Rule requirements under 45 CFR Part 164 — built in as standard, never optional add-ons.
End-to-End Encryption
All PHI in and through RevenuePro is encrypted in transit and at rest using industry-standard protocols — never exposed in readable form outside authorized access sessions.
Role-Based Access Control
Granular RBAC restricts access strictly to what each role requires — minimizing insider-threat exposure and enforcing HIPAA’s minimum-necessary standard at all times.
Secure Cloud Data Storage
Patient and billing data is hosted in HIPAA-compliant cloud infrastructure with physical, administrative, and technical safeguards — assessed regularly via third-party security testing.
Multi-Factor Authentication
All accounts require MFA at login, preventing unauthorized access even if credentials are compromised. MFA is enforced at the system level and cannot be disabled by users or admins.
Audit Trails & Activity Logs
Immutable, tamper-resistant trails record who accessed what, when, and from where. Every PHI action is logged and time-stamped, retained per HIPAA and ready for audit or breach review.
Disaster Recovery & Continuity
Automated backups with defined RTOs and RPOs plus redundant infrastructure ensure minimal downtime and zero PHI loss — critical for uninterrupted revenue cycle operations.
Defense-in-depth, by design
A layered model ensures that a breach at any single layer never compromises the overall integrity of patient data — verified through annual Security Risk Assessments and third-party penetration testing.
Automated Compliance Updates
RevenuePro’s compliance engine automatically incorporates changes to CMS billing rules, HIPAA regulations, and other federal standards — so providers never manually track regulatory change.
Data Anonymization
Reporting and analytics de-identify PHI using HIPAA Safe Harbor or Expert Determination methods, so operational insight is extracted without exposing identifiable patient data.
Zero Trust Architecture
No user, device, or network segment is automatically trusted. Continuous authentication, micro-segmentation, and least-privilege access apply at every layer of the platform.
Third-Party Integration Privacy
All API integrations undergo vendor risk assessments and must sign BAAs before any data exchange — over encrypted channels with scoped data access.
Data & Compliance
Encryption in transit and at rest, immutable audit trails, and continuous regulatory alignment form the outermost protective layer.
Application Security
MFA and role-based access controls govern who can reach the platform and exactly what each identity is permitted to do.
Network Security
A Zero Trust perimeter with micro-segmentation guards the innermost core — no implicit trust, ever.
Defense-in-depth is not a marketing claim — it is a structural design principle, continuously validated.
Patient Rights & Transparency
Patient rights are not merely regulatory obligations — they are fundamental ethical commitments. Our policies and RevenuePro’s patient-facing features uphold every right afforded under HIPAA and applicable federal and state law.
Right of Access to Billing Records
A secure patient portal lets individuals request, view, and download their billing information in a timely manner — without unnecessary barriers or fees.
Notice of Privacy Practices
Our NPP clearly explains how PHI is used, disclosed, and protected — provided at point of service and prominently available on our website and patient portal.
Patient Consent & Authorization
RevenuePro manages authorization forms and consent workflows digitally — documented, time-stamped, and retained — distinguishing disclosures that require authorization from those that don’t.
PHI Restriction Requests
Patients may restrict how PHI is used or disclosed, including the mandatory restriction for out-of-pocket payment scenarios — tracked and enforced within RevenuePro.
Privacy Complaint Process
A clear, documented, non-retaliatory pathway lets patients file a complaint with Revenue RCM LLC or directly with the OCR — fully compliant and responsive.
Where privacy needs extra nuance
Protecting Minors’ Data
Configurable access controls for pediatric records honor state minor-confidentiality laws and HIPAA’s deference to state law where a minor’s confidentiality may conflict with parental access.
Financial Information Security
Payment card data is handled per PCI DSS and strictly segregated from clinical billing data — card and banking details are never stored in RevenuePro’s PHI environment.
Medical Debt Collection Privacy
Collections workflows comply with the FDCPA and HIPAA’s payment-purpose disclosures. Identifying data is shared with collection partners only as strictly necessary, governed by a BAA.
Communication Preferences & TCPA
We track patient communication preferences under the TCPA and email regulations — opt-outs are honored promptly across all RevenuePro touchpoints.
RCM Operations & Data Handling
Where regulatory intent meets practical execution. Every step of the revenue cycle — from registration through final remittance — is engineered with privacy and security as primary requirements, especially where PHI is most actively in motion.
Patient Data Intake
Secure demographic and insurance data collection with the minimum-necessary standard applied from day one.
Claim Preparation
Coded claims are validated for accuracy under CMS, AMA, and FCA standards before electronic submission.
Secure EDI Submission
Electronic claims travel via encrypted EDI pathways to clearinghouses and payers per HIPAA transaction standards.
Denial Management
PHI protection is maintained throughout denial-appeal workflows with full audit-trail documentation.
Remittance & Reconciliation
Overpayments and refunds are processed through secure financial workflows with clear data-segregation protocols.
Compliance, executed end to end
Business Associate Agreements
Every vendor, clearinghouse, and partner handling PHI executes a comprehensive BAA before any data exchange — reviewed annually and tracked within our vendor risk management program.
Telehealth Billing Privacy
Specialized workflows address telemedicine’s unique privacy needs — platform security, cross-state licensing billing, and remote service modifiers — with the same PHI protections as in-person care.
Staff Privacy Training
All personnel receive role-specific, scenario-based HIPAA training at onboarding and annually — including phishing simulations — with documented completion tracking.
Secure Document Management
Physical documents are digitized, encrypted, and originals destroyed per HIPAA disposal rules. Retention schedules, access controls, and version tracking apply across the record lifecycle.
Physical Security — Kalispell HQ
Controlled workstation access, visitor management, and workstation-use policies prevent unauthorized PHI viewing — reviewed in our annual Security Risk Assessment.
Proper Disposal of ePHI
End-of-life devices and expired data undergo cryptographic erasure and physical media destruction — logged, with certificates of destruction retained as compliance records.
Evolving Threats & Incident Response
Healthcare is the most frequently targeted industry for cyberattacks. Revenue RCM LLC treats cybersecurity as an active, ongoing discipline — continuously tested, updated, and refined — not a static configuration.
Ransomware Defense
Endpoint detection and response (EDR), network segmentation, and immutable backups are designed to minimize ransomware impact and enable rapid recovery — without paying ransom.
Incident Response Plan
A documented plan covering detection, containment, eradication, recovery, and post-incident review — tested annually through tabletop exercises against emerging threat vectors.
Anti-Phishing Controls
Email security gateways, DMARC/DKIM/SPF enforcement, and regular phishing simulations protect personnel from increasingly sophisticated social-engineering attacks.
HIPAA Breach Notification
Confirmed breaches of unsecured PHI trigger protocols meeting 45 CFR §§ 164.400–414 — including 60-day individual notification, HHS reporting, and media notice where applicable.
Billing integrity, structurally enforced
False Claims Act
Coding accuracy protocols, RevenuePro’s claim-scrubbing technology, and internal audits prevent FCA violations. Every claim is auto-validated against CMS LCD/NCD criteria and AMA CPT standards before submission.
Health Care Fraud
A zero-tolerance anti-fraud culture plus built-in compliance edits and comprehensive audit trails give providers a defensible record of billing integrity. Annual FWA training is mandatory for all staff.
FTC Health Breach Notification
The FTC rule extends breach obligations to vendors of personal health records not covered by HIPAA. We monitor FTC guidance and apply its requirements wherever applicable.
Annual Security Risk Assessments
A comprehensive yearly SRA covers vulnerability scanning, policy gap analysis, physical safeguard review, and threat modeling — documented, prioritized, and tracked through remediation.
Anti-Kickback Statute Adherence
Operations and partnership structures are reviewed against the AKS so no remuneration arrangement creates prohibited inducements — all reviewed by compliance counsel before execution.
Confidential Reporting
Any identified billing irregularity triggers an immediate internal review. A confidential, non-retaliatory reporting mechanism lets staff raise compliance concerns without fear.
AI & RevenuePro — privacy by design
AI and machine learning are transforming RCM — automating coding, predicting denials, accelerating reconciliation. We integrate AI into RevenuePro in a way that prioritizes privacy by design and maintains full regulatory compliance.
Privacy by Design
All AI models are trained on de-identified or synthetic data. PHI is never raw training input, and model outputs undergo privacy impact assessments before production deployment.
Secure Automated Coding
AI coding recommendations are decision support for human coders — not autonomous billing actions — preserving accountability, clinical judgment, and FCA compliance.
Explainable AI & Audit Readiness
AI implementations are explainable, with audit trails for algorithmic decisions that withstand OIG or OCR scrutiny — tracking model versioning, decision logic, and accuracy.
Continuous Regulatory Adaptation
As HHS, FTC, and state regulators develop AI-specific guidance, we engage with industry working groups and legal counsel to keep RevenuePro’s AI at the leading edge of compliance.
“Compliance is not the ceiling — it is the floor. Our commitment to patient privacy, data security, and billing integrity extends far beyond regulatory minimums, because the trust of every patient whose data passes through our system demands nothing less.”
For compliance inquiries, Business Associate Agreement requests, or procurement documentation, contact our team at info@revenuercm.com · (971) 717-3335 · www.revenuercm.com.