RCM / INFUSIONEST. OPS
Infusion Revenue Cycle

Infusion RCM, built around the claim before it becomes a problem.

Ruby's infusion-specialty billers and platform run benefits, auths, claims, denials, and AR for you. You get one clear view of where the money is.

Book a walkthrough → See the workflow ↓

30 minutes · No prep needed

Fig. 01 · The owner view
⚠Auth renewed before lapse
✓Payment posted · reconciled
app.rubyrcm.com / owner-view
Handled by Ruby this weekno action needed from you
Appeal filed · medical necessityBCBS · Infliximab J1745 · $14,820
Filed
Auth renewed before lapseUHC · Ocrelizumab J2350 · next 3 cycles covered
Secured
Underpayment recoveredHumana · line-level variance · +$870
Posted
Payer follow-up call loggedCigna · IVIG J1569 · ref #44182 · recheck Tue
On cadence
Needs your decision: 1 · write-off approval over your threshold · everything else is handled
Review
Why Infusion Is Different

Infusion billing breaks generic RCM workflows.

01

Buy-and-bill exposure

One denied biologic can tie up tens of thousands in drug cost.

J1745 · $14,820 at risk
02

Prior auth drift

Renewals lapse mid-treatment cycle. Nobody notices until the denial.

Auth expires in 9 days
03

Payer-specific denials

Every payer denies differently. Generic queues hide the pattern.

Medical necessity · UHC
04

Underpayments hidden in remits

Paid-but-short becomes a write-off without line-level review.

−$870 vs expected
The Workflow

One path. Ruby owns every step.

Our team works the queue. You see status, not busywork.

01/ 07
Scheduled

Scheduled

Treatment plans enter the revenue cycle at scheduling, not at billing.

Benefits

Coverage and patient responsibility confirmed before the chair date.
Site of careBuy-and-bill

Prior Auth

Tracked against payer policy. Expirations surface before they lapse.
Medical policyAuth expiration

Claim

Units and codes checked against the order before submission.
J-codeNDCUnits

Denial & Follow-up

Categorized by root cause, routed with evidence attached.
Medical necessityPayer follow-up

Payment

Posted and reconciled against expected reimbursement, line by line.
PostedUnderpayment flagged

AR Review

Aging balances prioritized by value, age, and payer behavior.
Expected reimbursementAR > 60
Your View

You don't need another tool to manage. You need to know it's handled.

01 · Inside Ruby's operation

Every claim has an owner, status, next action, and deadline.

Worked by our team, not yours. Nothing waits in a spreadsheet. Nothing depends on memory.

Workqueue42 open · sorted by priority
Patient / DrugPayerAmountStatusNext action
D. WhitfieldOcrelizumab · J2350UHC$31,250Benefits pendingVerify site of care · Wed
M. OkaforVedolizumab · J3380Aetna$9,640Med necessity denialAppeal draft ready · Thu
L. TranIVIG · J1569Cigna$22,480Follow-up dueCall payer · today
A. PruittUstekinumab · J3357Humana$18,360Underpayment flaggedLine review · Fri
J. CastellanosRituximab · J9312Medicare$11,975AR > 60Escalate · today
02 · What's at risk, in plain sight

Denials grouped by root cause, payer, dollars, and deadline.

You see what's at stake and what we're doing about it, without working a queue.

Denialsgrouped by root cause
Medical necessityBCBS · UHC · 3 appeals due this week
$96,4008
Auth mismatchAnthem · renewal lapsed mid-cycle
$41,2004
Units exceed policyCigna · J1569 unit limits
$28,9003
NDC mismatchHumana · resubmit with corrected NDC
$12,3002
03 · Where the money is

Payments reconciled against expected, line by line. AR you can read in five seconds.

Underpayments become recoveries, not write-offs. No month-end surprises.

Remit · R. AlvarezERA 8841 · BCBS
InfliximabJ1745 × 40
Expected$14,820
Posted$13,950
Variance−$870
Admin · first hour96413
Expected$285
Posted$285
Variance$0
AR agingby bucket
0–30
$1.9M
31–60
$610K
61–90
$295K
90+
$117K
Operating Model

Automation where it helps. Operators where judgment matters.

Ruby's billers work the platform daily. Automation preps the work; experienced people make the calls. You don't manage any of it.

AI-assisted workflows

prepared, flagged, drafted
  • Payer note summaries
  • Appeal draft prep
  • Denial categorization
  • Missing documentation flags
  • Workqueue prioritization

RCM operators

the calls only experience can make
  • Benefits verification review
  • Auth follow-up
  • Payer calls
  • Denial resolution
  • Cash posting support
The Ugly Details

Built for the parts of infusion nobody puts on a slide.

Buy-and-bill Specialty biologics J-codes & NDCs Unit limits Site-of-care rules Buy-and-bill Specialty biologics J-codes & NDCs Unit limits Site-of-care rules
Recurring treatment cycles Auth expirations 340B considerations Specialty pharmacy handoffs Medical necessity appeals Recurring treatment cycles Auth expirations 340B considerations Specialty pharmacy handoffs Medical necessity appeals
What Changes

Operational shifts, not promises.

Scroll sideways
01 / 06
Chasing your biller for updates
↓
A live owner view, always current
02 / 06
Month-end surprises
↓
Live AR visibility
03 / 06
Generic denial buckets
↓
Infusion-specific root causes
04 / 06
Auths found expired
↓
Expirations surfaced early
05 / 06
Claims sitting untouched
↓
Every claim owned, with a deadline
06 / 06
Follow-up by memory
↓
Consistent payer cadence
Who It's For

Built for groups that own the drug risk.

  • Independent infusion centers01
  • Specialty infusion practices02
  • Multi-site infusion groups03
  • MSOs04
  • PE-backed specialty platforms05
  • Groups expanding into infusion06

Make infusion reimbursement easier to control.

See how Ruby turns fragmented benefits, auth, denial, payment, and AR workflows into one operator-ready system.

Book a walkthrough →

HIPAA-compliant operations. PHI handled under BAAs with strict access controls.