Revenue Cycle Transformation Improves Net Collection 25%
End-to-end RCM outsourcing for a healthcare provider network — targeting denial reduction and faster claims settlement.
The Challenge
A 12-facility healthcare provider network was experiencing a 22% claims denial rate, Days in AR of 54, and a net collection rate 18% below national benchmarks. Billing was handled by a fragmented in-house team with inconsistent coding practices across facilities.
Our Approach
Took over end-to-end RCM: charge capture, medical coding, claims submission, denial management, and AR follow-up.
Deployed payer-specific coding guidelines for the top 8 payers covering 82% of claim volume — reducing coding-based denials by 60%.
Built a denial management workflow: automated denial categorisation, root-cause tagging, and appeal filing within 72 hours of denial receipt.
Established a dedicated AR follow-up team working aged receivables >30 days with daily prioritisation by balance and payer.
Monthly QBRs with CFO and Revenue Cycle Director — tracking net collection rate, denial rate, Days in AR, and clean claim rate.
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