
Cutting denials by two-thirds and freeing trapped A/R for a multi-specialty group
A 22-provider multi-specialty physician group in the Southeast (primary care, cardiology, orthopedics, and GI)
97%
First-pass clean claim rate (up from 82%)
-64%
Reduction in claim denials over 9 months
34 days
Days in A/R (down from 58)
+29%
Net collections lift
The challenge
The group was losing revenue to a rising denial rate and a backlog of aged claims, with more than a third of its A/R sitting past 90 days. A thin in-house billing team was working reactively — reworking denials one at a time without addressing root causes — so clean claim rates hovered in the low 80s and cash flow stayed unpredictable across specialties.
What we did
- Ran a full RCM audit across all four specialties to categorize denials by payer, CARC/RARC code, and root cause, then prioritized the highest-dollar and highest-volume drivers
- Deployed certified coders (ICD-10/CPT/HCPCS) and front-end claim scrubbing to catch eligibility, coding, and demographic errors before submission
- Stood up a dedicated denial-management and appeals workflow with payer-specific playbooks, so denials were worked in batches by cause rather than one-off
- Launched a structured aged-A/R cleanup on the 90+ day backlog, sequencing accounts by recoverability and timely-filing deadlines
- Added weekly KPI reporting (clean claim rate, denial rate, days in A/R, net collections) with a 24/7 team feeding trends back into front-end edits
We were drowning in denials and honestly didn't know where the money was leaking. Within a couple of months we could see exactly which payers and codes were costing us, and the aged claims we'd written off in our heads started turning into deposits. The weekly numbers keep everyone honest.





