Medical Billing & RCM
Project Overview
By January 2026, this practice was bleeding revenue in four specific ways: denials were piling up with no root-cause tracking, charges sat unbilled with no lag monitoring, patient responsibility had crept to 26% of total charges with no recovery workflow, and a complex payer mix left leadership with no visibility into where AR was aging. On paper the practice looked stable. In practice, denial dollars alone had reached $209,000 a month.
The team behind this engagement moved on five fronts at once: a hard 0–7 day charge submission rule (98.88% of claims hit that window), root-cause mapping across 14,700+ denial instances with payer-specific resolution tracks, a structured self-pay recovery workflow that brought in $200K and dropped patient responsibility to 18%, active AR aging control that kept 90+ day balances to just ~$23K, and monthly payer-level reporting to guide decisions.
What 63% Fewer Denials Actually Looks Like
A multi-specialty outpatient practice cut monthly denial dollars from $209K to $78K in four months a real, published industry example of what disciplined RCM can do.
Zero-lag charge capture
Root-cause denial resolution
Structured AR & self-pay recovery
The Results
$1.13M+ billed, denial dollars down 63% ($209K → $78K), and 98.88% of claims filed within a week of service — all in four months. It's the same discipline our own in-house audit team is built around, which is why we're showing it here.
