The situation
Three locations billed through two different workflows, with no single owner for denials. Device-check claims were bundled incorrectly, and stress test claims were routinely denied for medical necessity.
The group's in-house team was fully occupied posting payments and answering patient calls; nothing older than 60 days was being worked at all.
What we did
- 01
We inventoried the full A/R, ranked it by dollar value and timely-filing runway, and worked the collectible pool first.
- 02
Coding review corrected professional/technical component splitting and device monitoring intervals before claims went out.
- 03
Denials were tagged by root cause; the top three drivers became scrubber rules, which stopped the repeat.
- 04
A daily follow-up cadence replaced ad-hoc calling, with weekly aging movement reported to the practice administrator.
The result
- — Days in A/R dropped from 71 to 44 within two quarters and to 41 by month nine.
- — $1.1M recovered from aged and denied claims, including claims the previous vendor had written off.
- — Denial rate fell from 16% to 5.8%; repeat denials fell by 61%.
- — The in-house team moved from claim chasing to patient experience work.
"The difference was not that they worked harder on our denials. It was that they told us why the denials happened and then made them stop happening."