Impact

A large, not-for-profit academic health system operates a multi-hospital network with a broad outpatient footprint and a high-volume physician enterprise. The provider’s near-term goal was straightforward: bring PB Radiology inventory back under control, keep current volume moving, and maintain coding quality while the backlog was reduced.

Vee Healthtek was brought in to run the recovery like an operating system - prioritized, visible, and governed - rather than a one-time staffing push.

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The Challenge

The provider was not facing a routine work queue cleanup. It needed to address three pressures at once: older Radiology inventory, new weekly volume, and encounters moving closer to timely filing thresholds. The issue was not only the size of the backlog; it was the fact that incoming work continued while aged inventory still had to be cleared.

The primary bottleneck was capacity. The available resource model was not sufficient to manage both backlog and incoming volume simultaneously, and if the situation was not addressed promptly, it could delay billing and reimbursement cycles. In short: the work could not simply be pushed harder through the same model. It had to be prioritized, segmented, staffed differently, and governed more tightly.

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The Solution

We ran the backlog recovery as a measured, governed operating model rather than a one-time staffing push. Our approach was anchored in four mechanisms:

• Production control with risk-based prioritization: Prioritized timely filing-sensitive inventory first, then shifted into a hybrid model that kept 2026 date-of-service inventory close to current while continuing to reduce older 2025 date-of-service inventory.
• Complexity-based workflow segmentation: Separated simpler Radiology work from more complex charts. Simpler modalities and lower-complexity charts were routed to appropriate resources, while experienced Radiology coders stayed focused on complex charts where accuracy risk was higher.
• Rapid capacity expansion with dedicated current-volume coverage: Expanded capacity through skilled coders across multiple locations, part-time support, weekly onboarding, and extended weekday and weekend coverage. A dedicated team also handled regular incoming inventory so new volume did not simply become the next backlog.
• Quality governance and daily operating discipline: The recovery was managed through daily stand-ups, work allocation routines, dedicated reporting ownership, quality consolidation, and weekly provider status reviews. Audit controls, error-trend analysis, corrective action planning, and refresher education helped keep quality stable during the ramp.

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The Impact

• Processed 1 million+ PB Radiology records during the recovery period, helping clear a high-volume backlog while keeping current Radiology coding work moving.
• 8 months of backlog completed in 16 weeks, with the 2025 PB Radiology backlog completed and 2026 DOS brought to a nearly current position.
• Collections run-rate lift: average monthly collections increased from ~$490k/month to ~$680k/month (~38% uplift).
• Weekly throughput scaled from about 10,000 to 130,000 records giving the provider the capacity needed to reduce aged inventory while continuing to absorb new weekly volume.
• Radiology coding quality held at 96% during the 2026 recovery period, even as production accelerated sharply.

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Why Us

The provider wanted a partner who could operate inside complex academic health system workflows, handle high-volume Radiology coding, and stand up to intense operational scrutiny. Prior Radiology performance helped open the door; disciplined execution, quality control, and a transparent operating model closed the loop.

“What stood out was how closely the team partnered with us throughout the recovery. They listened, adapted quickly, and helped us regain control without losing sight of quality.”
- Finance Leader

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Transferable Insights

Treat backlog recovery as a control system, not a cleanup project. When aging specialty inventory threatens timely billing, the answer is not simply adding more people. The stronger model is to prioritize by financial and filing risk, segment work by complexity, assign specialized resources where accuracy matters most, and maintain daily visibility through governed reporting and audit loops. That is how health systems can increase throughput without trading speed for quality.

A Midwestern, not-for-profit academic health system operates a multi-hospital network, a wide outpatient footprint, and a large employed physician enterprise. As clinical growth scaled, the physician enterprise needed to convert more visits into clean, payable claims while reducing the A/R inventory already sitting in workqueues.

The organization engaged our team through a trusted peer reference and needed support that could work inside EHR environments and academic health system complexity. The operating approach started where cash was trapped and where workqueue signals were clearest, then expanded through deliberate modules that connected throughput with prevention.

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The Challenge

Revenue cycle leaders faced backed-up professional A/R, rising denials and edits, and uneven coding practices across specialty departments. The operating constraint was practical: too many claims needed touches, too many touches did not convert into payment, and too much revenue cycle know-how lived in disconnected workflows.

The difficulty of finding and retaining experienced revenue cycle talent amplified the issue. A pure staffing push would not address repeated claim defects, EHR logic gaps, or inconsistent coding and revenue integrity patterns. The provider needed workqueue execution that released cash and a feedback loop that moved repeat issues upstream into system logic, edit rules, and education.

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The Solution

Professional billing A/R execution with EHR claim logic hardening

We delivered end-to-end revenue cycle support as modular building blocks, sequencing the work around trapped cash, recurring errors, and specialty-specific revenue integrity signals. The approach was anchored in four mechanisms:

• Professional billing A/R follow-up and payment investigation: Executed workqueues with focus on aged inventory and high-value next actions, giving the physician enterprise a structured path to reduce outstanding balance and account volume.
• PB denials and edits management: Triaged denials and edits, corrected claims, routed resubmissions and appeals, and captured prevention opportunities as repeatable rules when patterns appeared.
• Coding audits, reconciliation, and revenue integrity: Performed detailed chart audits and reconciliation sweeps to surface missed charge capture, then anchored provider and coder education in findings from actual specialty work.
• EHR claim logic and edit-rule prevention: Paired operational throughput with system hardening by moving repeated issues into EHR claim logic and edit rules, including a permanent edit to auto append Modifier 59 in the triggering scenario.

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The Impact

• A/R balance decreased from $76M to $46M with total account count dropping from 4,000 to 2,100 across the physician enterprise A/R work.
• Aged A/R risk fell across key buckets with balances in 91-180 days down 55%, 181-360 days down 53%, and 360+ days down 44%.
• Average monthly collections increased from approximately $490k/month to approximately $680k/month representing approximately 38% uplift in collections run rate.
• 109,000 invoices were processed in 90+ day inventory supporting targeted aged A/R resolution inside the professional billing workflow.
• 40%+ of impacted accounts were subsequently paid after CPT logic correction after an inclusive denial pattern was addressed, followed by a permanent EHR edit to auto append Modifier 59 in the triggering scenario.

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Why Us

The provider wanted a partner who could operate inside EHR workqueues, handle specialty nuance, and withstand intense operational scrutiny in an academic health system setting built around transparency and detail. A trusted peer endorsement opened the door, while performance discipline, prevention, and the ability to convert repeat work into EHR and edit-rule fixes shaped the engagement.

“You’re not a vendor, we treat you like an extension of our team.”
- Finance Leader

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Transferable Insights

For health system CFOs, Chief Revenue Cycle Officers, and physician enterprise leaders, the practical lesson is to sequence throughput and transformation. Start with aged A/R, denials, and edits that trap cash, then convert repeat defects into EHR claim logic, edit rules, and education so clean-claim performance improves beyond the immediate workqueue.

A large Southwest nonprofit health system needed to maintain dependable facility and professional coding flow while strengthening its pre-bill revenue integrity controls. Growth increased throughput demands and raised the cost of coding variability across DNFB sensitivity, denial triggers, and Diagnosis-Related Group (DRG) audit exposure.

The provider engaged our team to operate the work as a measured, visible, and governed system. The operating model connected coding production, quality analytics, and pre-bill DRG validation so inpatient claims could move with stronger controls before submission.

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The Challenge

Revenue cycle and coding leaders measured success through accuracy and turnaround time. Those measures had to hold through volume spikes, PTO seasons, and backlog events, at the same time that inpatient claims needed more disciplined DRG review before billing.

The operational risk involved both sides of DRG accuracy: missed legitimate reimbursement from down-coded accounts and avoidable over-coding exposure from up-coded accounts. A standalone audit model would not solve the throughput problem or feed learning back into coder workflows. The provider needed a governed pre-bill control that could improve coding accuracy without slowing claims.

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The Solution

A governed, tech-enabled DRG validation engine

We built a workflow that treated DRG validation as an operating control across production, quality, and revenue integrity. The approach was anchored in four mechanisms:

• Production control with performance visibility: Used recurring, structured reporting for volume and quality across chart types, including IP, DRG review, observation, surgery, and endoscopy, to create a predictable operating cadence.
• Quality analytics and closed-loop CAPA: Tracked error trends, performed root-cause analysis, and reinforced corrective and preventive action through targeted education on PDx, CC/MCC validation, PCS capture, disposition, and POA.
• Pre-bill DRG validation control: Prioritized high-impact cases, reviewed the full medical record against coding guidance, issued compliant corrections and query opportunities, and fed learnings back into coder workflows.
• Governed platform transition support: Supported a major platform transition in the coding environment within the same governance model so throughput remained predictable instead of treating the transition as a side event.

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The Impact

• DRG validation delivered about $784,000 in total value by recovering legitimate reimbursement from down-coded accounts and preventing over-coding exposure from up-coded accounts.
• Quality held at about 99% across more than 5,200 facility accounts comfortably above the 95% benchmark while maintaining steady throughput across chart types.
• DRG audit corrections produced about $205,000 in combined impact by improving under-coding and reducing over-coding exposure before claim submission.
• Coding throughput stayed predictable across chart types including IP, DRG review, observation, surgery, and endoscopy, supported by volume and quality reporting routines.
• Coder feedback loops strengthened DRG accuracy controls through dashboards, trend analytics, standardized feedback, and CAPA tied to documented coding topics such as PDx, CC/MCC validation, PCS capture, disposition, and POA.

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Why Us

The provider prioritized risk-managed adoption and operational confidence. The work started small, validated performance, and expanded scope while maintaining control. The provider valued the ability to ramp coverage during backlogs and peak periods while staying consistent on accuracy and turnaround time, alongside satisfaction with security and operational reliability.

“When volume spikes hit, you ramp quickly - and quality still holds.”
- Leader

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Transferable Insights

For health system CFOs, Chief Revenue Cycle Officers, and HIM, coding, CDI and mid-cycle leaders, the practical lesson is to treat DRG validation as a pre-bill control system. Pair clinically informed review with dashboards, trend analytics, CAPA, and coder feedback so revenue integrity improves while coding throughput remains visible and governed.

A Midwest not-for-profit, multi-hospital health system serving a tri-state region had positioned itself as a long-term community partner. It served patients through 20 hospital locations that were owned, joint-ventured, sponsored, or affiliated, along with 150+ care locations across the region.

By mid 2023, acquisitions and market expansion increased revenue cycle volume and complexity faster than local staffing capacity could absorb. The organization needed an operating partner that could stabilize multiple workstreams inside its existing EHR, earn confidence in smaller communities, and give CFO and Revenue Cycle leaders a clearer view of capacity, throughput, turnaround-time adherence, and QA.

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The Challenge

Growth created pressure across the revenue cycle. Denials from payers were rising, labor costs were increasing, and tight labor markets made it harder to sustain margins. Coding, authorizations, and A/R follow-up became harder to staff consistently, while reimbursement pressure raised the consequences of missed work, delayed work, and inconsistent work.

The operating constraints were practical and non-negotiable. EHR access and security templates had to follow vendor and IT timelines. Delivery also had to feel indistinguishable from an internal team, especially in smaller communities where confidence had to be earned quickly. The provider needed more than capacity; it needed a governance spine, measurable controls, and consistent execution across sites and workstreams.

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The Solution

A governed Revenue Cycle operating model inside the existing EHR

We supported end-to-end Revenue Cycle performance through a standing cadence that made work visible, measurable, and scalable without changing the provider's core systems. The approach was anchored in four mechanisms:

• Standing functional cadence: Ran weekly functional sessions across coding, hospital billing and professional billing A/R, claim edits, prior authorizations, credit balance, and medical records indexing, supported by monthly look-backs and executive-level quarterly governance.
• EHR-based delivery and queue visibility: Kept the EHR as the system of record while layering queue instrumentation, action-code analytics, and capacity reporting into daily execution so leaders could see throughput, turnaround-time adherence, QA, and risk.
• QA discipline and standardized work: Used structured QA audits and standardized work instructions to reduce variation across sites and specialties, giving teams repeatable requirements for coding, A/R, authorizations, claim edits, credit balance, and indexing.
• Automation pathways where permitted: Advanced payer portal and EDI-style workflows for eligibility, status checks, and authorization tracking, while aligning to a broader roadmap for workflow tooling and AI, NLP, and OCR acceleration for coding and denials prevention.

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The Impact

• Zero backlog was maintained across major workstreams despite growth in scope, volume, and operating complexity across a multi-hospital environment.
• 95-98% QA was sustained across coding and revenue cycle teams giving finance and Revenue Cycle leaders a consistent quality signal while the work scaled.
• Professional billing A/R accounts addressed rose ~24% YoY as scope and volume grew inside the provider's existing operating environment.
• Hospital billing A/R accounts addressed rose ~40% YoY with quality around ~99% against a 95% threshold.
• Average PFL inventory fell 59% while prior authorization denials stayed near ~1%, with ~93% of authorization cases verified as not required or approved.
• Indexing handled 20k-23k documents per month with ~0.10% exception rate and a 4,117-item payment validation cleanup was completed in 17 days when surge support was needed.

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Why Us

The provider chose the team for confidence in execution. Leaders emphasized reputation, follow-through, peer references, and a track record supporting complex health systems with demanding operating standards. They also valued a high-touch operating model that translated day-to-day issues into coordinated action across delivery teams without forcing internal leaders to manage disconnected workflows.

As one leader described the kind of partner the organization wanted:

"High trust, high touch, and principled - committed to getting it right even when it’s hard."
- Health System Leader

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Transferable Insights

For CFOs, Chief Revenue Cycle Officers, and functional leaders, the practical lesson is that end-to-end Revenue Cycle scale depends on a governance spine plus measurable controls. When workstream ownership, QA discipline, and EHR-based visibility operate together, daily queues can become a more reliable signal for executive confidence.

A Midwest-based outpatient health system with more than 100 clinics needed to stabilize a front-office revenue cycle issue that was creating material downstream exposure. Each month, preventable eligibility denials affected approximately $8 million in claims, disrupting cash flow, adding staff burden, and increasing revenue leakage across eligibility-dependent workflows.

The provider engaged our team to overhaul denial workflows and streamline intensive manual processes. The operating response combined root cause analysis, denial analytics, RevAmp automation, and agentic AI eligibility verification to prioritize high-risk work, accelerate payer verification, and help staff focus on higher-value activities.

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The Challenge

The provider faced a denial problem rooted in eligibility and benefits verification, insurance data quality, documentation gaps, and slow manual workflows. A review of 240 denials found missing documentation, incorrect insurance and demographics data, and manual process delays as the top reasons for denials. These issues affected work before claims moved forward and created avoidable rework after denial generation.

The business risk was significant because preventable eligibility denials were impacting approximately $8 million in claims each month. The existing workflow depended heavily on manual effort, which limited throughput and made it harder to prioritize high-risk verifications quickly enough to prevent downstream authorization, reimbursement, cash-flow, and staff-capacity pressure.

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The Solution

Agentic AI eligibility verification with denial analytics

We supported eligibility denial reduction through a technology-enabled operating model that paired denial analytics with agentic AI verification and governed workflow prioritization. The approach was anchored in four mechanisms:

• Root cause analysis and denial analytics: Performed a full-spectrum root cause analysis and used detailed analytics to identify missing documentation, incorrect insurance and demographics data, and slow manual workflows as leading contributors to preventable eligibility denials.
• Agentic AI eligibility verification: Deployed RevAmp agentic AI to verify eligibility status by phone and through EDI transactions, enabling high-volume payer communication and reducing manual bottlenecks in the verification workflow.
• Custom prioritization for high-risk work: Configured prioritization workflows so high-risk verifications moved first, helping the provider address eligibility checks that could delay authorization, reimbursement, or payment if left unresolved.
• Dashboards, reporting, and workflow optimization: Used revenue cycle dashboards, reporting tools, historical eligibility denial data, payer-behavior signals, and prior outcomes to adjust workflows for throughput, resource allocation, accuracy, and productivity.

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The Impact

• Eligibility denials reduced by 26% over the five-month engagement period through technology-enabled workflow processes and agentic AI eligibility verification model.
• More than $3.6 million in average monthly savings after automation of eligibility and benefits checks across thousands of patient encounters and payer direct connect through RevAmp.
• 41% productivity boost after automating eligibility and benefits checks, payer direct connect, and high-risk verification prioritization across the workflow.
• 39% reduction in labor hours as automation reduced manual verification effort and freed staff to focus on higher-value work.
• Verification timeline performance increased by 133%, alongside productivity improvement and labor-hour reduction during the five-month period.

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Why Us

The provider selected us because we combined an AI-driven revenue cycle solution with healthcare revenue cycle expertise, denial workflow knowledge, and technology capable of improving recovery, quality, and operational efficiency.

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Transferable Insights

For patient access, financial clearance, and revenue cycle leaders, this case shows that eligibility denial reduction requires more than working denials after they occur. When preventable eligibility denials affect large claim value, leaders can use denial root cause analysis, insurance and demographic data controls, risk-based verification prioritization, and direct payer automation to move resolution earlier in the revenue cycle while keeping results tied to measured operational outcomes.

A leading health system in the Northeast needed to improve engagement with Best Practice Alerts (BPAs) during pre-visit reviews. Providers were missing conditions and important contraindications, creating avoidable care risk and weakening the information available for risk adjustment factor (RAF) score calculation.

The provider had tried adding more BPAs inside its Electronic Health Record (EHR), but engagement continued to decline. The organization turned to the team after successful medical coding work because it needed clinical review, workflow redesign, and provider education that could make alerts useful rather than easy to dismiss.

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The Challenge

The provider was not facing a simple EHR build problem. It had already added more BPAs, yet provider engagement continued to fall. The problem grew from alert fatigue: providers saw a constant flow of irrelevant alerts, learned that many alerts would not help the pre-visit review, and often closed them without reading them.

That behavior created clinical, financial, and operational risk. Overlooked conditions and contraindications exposed the provider to preventable care errors. Missed conditions also reduced the completeness of RAF score inputs, creating missed opportunities for care planning and reimbursement. Continuing to build more ineffective BPAs would have increased cost without improving engagement.

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The Solution

Curated BPA redesign with provider-led feedback and training

We treated BPA performance as a clinical workflow and engagement problem rather than an alert-build volume problem. The approach was anchored in four mechanisms:

• Current BPA review: Evaluated the existing BPAs in the EHR to understand which alerts lacked relevance, where providers disengaged, and how the pre-visit review workflow shaped alert use.
• Individual provider feedback: Met individually with providers to learn why the alerts were ineffective and to identify the points where alert fatigue caused them to close BPAs without reviewing the content.
• Curated evidence-based BPA design: Worked with subject matter experts to create new BPAs based on provider feedback, then built evidence-based guidelines that helped providers align their workflow with the alerts during pre-visit reviews.
• Customized training and feedback loops: Implemented regular training sessions tailored to provider needs and preferences, using those sessions to answer questions, resolve concerns, and continue improving BPA effectiveness.

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The Impact

• BPA acceptance rate improved from under 50% to 90% after curated BPAs and training were implemented, giving leaders a measurable engagement change inside the pre-visit review workflow.
• Provider engagement increased 23% after the alert redesign, exceeding the provider's expectations for engagement improvement.
• RAF score accuracy improved because providers engaged more consistently with BPAs tied to pre-visit review and diagnosis capture.
• Fewer conditions were missed as decreased alert fatigue helped providers engage with alerts that were more relevant to care planning and documentation.
• Timely diagnosis capture and outcomes improved with the provider noting timely capture of patient diagnoses, reduced readmissions, and improved overall health outcomes.

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Why Us

The provider had already worked with the team on several successful medical coding projects and trusted the team's healthcare professional services experience. That prior performance, combined with clinical review expertise and reliability, made the team the preferred choice for addressing low provider engagement with BPAs.

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Transferable Insights

For CFOs, Chief Revenue Cycle Officers, HIM, coding, CDI, and risk adjustment leaders, the practical lesson is that EHR alerts need clinical relevance and provider trust. Adding more BPAs can increase noise if the workflow does not reflect provider feedback, evidence-based guidance, and recurring education. Better alert design starts with the reason providers ignore the alert.

A large hospital in the Northeast needed a more accurate Risk Adjustment Factor (RAF) score to reflect the true risk profile of its patient population. Clinical documentation gaps were causing under-capture of Hierarchical Condition Category (HCC) conditions, which limited reimbursement accuracy and weakened visibility into patient health needs.

The provider engaged the team to improve RAF accuracy through medical-record review, HCC condition capture, provider education, and Clinical Documentation Improvement (CDI) controls. The work centered on accuracy, quality, and compliance rather than a one-time coding correction.

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The Challenge

The provider had a documentation integrity problem with direct risk adjustment consequences. Missed HCC conditions and incomplete clinical documentation caused the average RAF score to understate patient risk. That meant the organization did not have a complete representation of patient acuity for risk stratification, care management, and reimbursement accuracy.

The existing documentation pattern could not solve the problem by itself because providers needed more specific feedback on what was missing and why the documentation did not support complete HCC capture. Without a structured CDI program, the same documentation gaps could continue to affect RAF score accuracy, coding completeness, and reimbursement outcomes.

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The Solution

HCC review and CDI education for RAF accuracy

We supported RAF optimization through a focused clinical documentation and HCC review model. The approach was anchored in four mechanisms:

• Medical-record review by HCC experts: Reviewed the hospital's medical records to assess provider documentation practices, identify missed HCC conditions, and locate documentation gaps affecting RAF score accuracy.
• Documentation gap closure: Rectified documentation gaps where the record did not fully support relevant HCC conditions, helping strengthen coding accuracy and completeness.
• Customized CDI education: Provided detailed feedback to providers through a customized clinical documentation improvement program focused on documentation accuracy, completeness, and HCC condition capture.
• Audits, performance tracking, and insights: Conducted frequent audits and reviews to track RAF scores, documentation completeness rates, and reimbursement outcomes, then shared comprehensive reports and data-driven insights to guide ongoing RAF optimization.

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The Impact

• Reimbursement increased by 6.1% as the average RAF score became more accurate after improved HCC condition capture and documentation feedback.
• Average RAF score accuracy improved giving the provider a more complete representation of patient risk for risk stratification and care management.
• HCC condition capture became more complete after medical-record review identified missed conditions and documentation gaps.
• Providers became more proficient in documenting relevant HCC conditions through the customized CDI program and detailed feedback tied to documentation accuracy and completeness.
• Reimbursement and care insight strengthened together because better RAF score accuracy supported financial performance and a clearer understanding of patient health needs.

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Why Us

The provider needed a partner with expertise in risk adjustment factor optimization, accuracy, quality, and compliance. The team brought HCC expertise, medical-record review capabilities, provider education, frequent audit discipline, and reporting that helped leaders see progress and identify additional RAF optimization opportunities.

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Transferable Insights

For CFOs, Chief Revenue Cycle Officers, HIM, coding, CDI and risk adjustment leaders, the practical lesson is that RAF accuracy depends on closing the loop between documentation review and provider behavior. HCC capture improves when teams identify missed conditions, explain documentation gaps, educate providers with case-specific feedback, and track RAF, documentation completeness, and reimbursement outcomes together.

A large, multi-specialty health system on the West Coast faced a serious cash-flow and revenue cycle risk. The organization had lost control of its accounts receivable as staffing shrank quickly and A/R processes became poorly managed.

The provider needed a strategic partner with revenue cycle management experience that could mobilize quickly. The engagement focused on urgent A/R stabilization, payer pattern analysis, denial management, and feedback to the front-end coding team so the same issues would not continue creating preventable denials.

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The Challenge

The provider was approaching a potential financial crisis because accounts receivable work had become difficult to control. A rapidly shrinking staff left the organization without the capacity and process discipline needed to contain outstanding balances, manage denials, and recover cash quickly enough.

The risk was not limited to the age of the receivables. Payer processing problems and coding-related denial patterns had gone unnoticed, allowing avoidable revenue loss to continue. The provider needed more than short-term labor; it needed payer-specialist review, denial workflow correction, front-end coding feedback, and an operating model that could restore visibility and accelerate collections.

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The Solution

Rapid A/R recovery with payer-specialist analysis

We treated the A/R crisis as a time-sensitive cash recovery and revenue leakage prevention problem. The approach was anchored in four mechanisms:

• Rapid mobilization within 15 days: Mobilized a dedicated team within 15 days of contract signing so the provider could address the accounts receivable issue without waiting through a long implementation cycle.
• Dedicated payer-specialist review: Assigned payer specialists to examine global trends and payment patterns, uncovering inefficiencies and discrepancies that had been missed inside the existing A/R process.
• Denial management and backlog reduction: Streamlined denial management processes, reduced backlog, and accelerated revenue recovery by focusing work on the accounts and payer issues most likely to affect cash flow.
• Coding feedback and prevention: Provided detailed analysis and feedback to the front-end coding team, helping address preventable denial contributors and supporting stronger coding accuracy going forward.

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The Impact

• Collections increased by $8 million in eight months helping relieve immediate financial strain and supporting ongoing operations and growth initiatives.
• Invoices over 120 days decreased from $16 million to $3 million showing a major reduction in aging exposure and a stronger ability to expedite revenue recovery.
• Average A/R days reached 40 days reducing the time between billing and payment and improving the manageability of the revenue cycle.
• $5 million worth of incorrectly processed payer invoices was identified after payer specialists reviewed global trends and payment patterns that had gone unnoticed.
• Denial management workflows became more controlled with backlog reduction, faster revenue recovery, and front-end coding feedback designed to prevent future denials.

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Why Us

The provider needed a strategic partner with extensive revenue cycle management experience, and A/R expertise that could act with a tight turnaround timeframe. The team brought dedicated payer specialists, denial management process expertise, medical coding capability, and analysis that connected immediate recovery with prevention.

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Transferable Insights

For CFOs, Chief Revenue Cycle Officers, business office leaders, and A/R recovery leaders, the practical lesson is that A/R recovery works best when it combines immediate cash action with root-cause prevention. Payer trend analysis, denial workflow control, and coding feedback help identify cash trapped in aging inventory and reduce the chance that the same patterns will rebuild the backlog.