The situation
Claims crossed multiple places of service, monthly capitated services and dialysis rounding patterns, but follow-up queues did not distinguish them.
Medical-necessity and frequency denials were appealed inconsistently, while smaller balances aged without a defined touch cadence.
What we did
- 01
We segmented A/R by place of service, payer, age and filing deadline, assigning each pool its own follow-up rules.
- 02
Nephrology coders reviewed monthly-service frequency and documentation before high-value claims were refiled.
- 03
Appeal templates were built around the top payer policies and denial reasons.
The result
- — A/R over 90 days fell 57% and days in A/R reached 40 within two quarters.
- — $534K in working capital was released from aged and denied balances.
- — Repeat denials declined 43% after payer-specific edits went live.
"We stopped treating dialysis A/R like one queue and started seeing steady movement every week."