Pediatrics

25% Revenue Increase in 6 Months

A multi-physician clinic in Florida was struggling with a 15% denial rate. Our RCM team reduced it to 3%.

Managing a high-volume pediatric practice in Florida comes with unique challenges, from complex Medicaid billing to a high frequency of seasonal visits. A prominent multi-physician clinic was facing a financial bottleneck: despite seeing more patients than ever, their bank account wasn't reflecting the hard work. Here is how we transformed their Revenue Cycle Management (RCM) to achieve a 25% revenue increase in just half a year.

The Challenge: Drowning in Denials When we partnered with the clinic, their financial health was compromised by a 15% denial rate. For every 100 claims sent out, 15 were coming back unpaid due to coding errors, eligibility issues, or missing documentation. This created a "leaky bucket" effect:

Stalled Cash Flow: Revenue was tied up in lengthy appeal processes.

Administrative Burnout: Staff spent more time chasing old money than managing new visits.

High Write-offs: Many claims were eventually abandoned because they exceeded timely filing limits.

The Strategy: Precision and Proactivity Our RCM team implemented a three-pronged approach to overhaul the clinic’s billing ecosystem:

Clean Claim Scrubbing: We deployed advanced scrubbing software tailored to Florida-specific pediatric codes (including Well-Child Visits and Immunization bundles) to catch errors before submission.

Eligibility Verification: We shifted the focus to the "front end," ensuring every patient’s insurance was verified 24–48 hours before the appointment. Aggressive Denial Management: Instead of just resubmitting, we analyzed the root cause of every denial, identifying a pattern of incorrect modifiers that was previously overlooked.

The Results: 6 Months to Success The impact of these changes was rapid and measurable. By the end of the second quarter, the clinic’s financial trajectory had completely shifted.

Cardiology

Resolving 2 Years of Backlog

Successfully recovered $450k in aged AR for a specialty cardiology group that was facing credentialing issues.

In the high-stakes world of cardiology, complex procedures and long-term patient management require precision—not just in the OR, but in the billing office. A specialized cardiology group found themselves in a financial crisis when two years of backlogged claims and unresolved credentialing issues threatened their practice’s viability.

Here is how we cleared the path and recovered $450,000 in aged Accounts Receivable (AR).

The Challenge: A Two-Year Financial Gridlock The practice was sitting on nearly half a million dollars in unpaid claims. The primary culprit wasn't a lack of patients, but a "perfect storm" of administrative hurdles:

Credentialing Chaos: Several providers were improperly credentialed with key payers, leading to automatic denials for high-value cardiovascular procedures.

Stale Claims: The 24-month backlog meant many claims were dangerously close to (or past) the "timely filing" limits.

Specialty Complexity: Coding for diagnostic imaging and interventional cardiology requires a level of nuance the practice's previous billing setup couldn't maintain.

The Strategy: Targeted Recovery and Correction We launched a "Rescue RCM" mission focused on immediate cash recovery and long-term structural repair:

Credentialing Cleanup: We performed an exhaustive audit of all provider enrollments, backdating credentials where possible and correcting provider data at the payer level to unlock stalled payments.

AR Deep-Dive: Our specialists categorized the $450k backlog by "likelihood of recovery." We prioritized high-dollar cardiac surgical claims and aggressively appealed denials based on medical necessity. Process Hardening: To prevent a new backlog, we implemented a real-time tracking system for "Pending Information," ensuring doctors provided the necessary clinical notes for complex codes immediately after procedures.