Case Studies

Revenue Cycle & Credentialing Case Studies

Protect Your Time. Strengthen Your Revenue. Elevate Your Practice.

Case Study 1: Oncology Revenue Cycle Management

Client Background

A Georgia-based oncology provider experiencing rising A/R, inconsistent billing workflows, and limited visibility into outstanding claims.

The Challenge
  • Aged A/R with claims 90–180+ days old
  • High denial rates due to missing documentation and inconsistent coding
  • No structured follow-up cadence or payer-specific escalation process
  • Lack of reporting and visibility into revenue leakage
Our Approach

1. Full Revenue Cycle Assessment

  • A/R stratification by payer, age, and denial reason
  • Identification of documentation and coding issues
  • Review of charge capture and eligibility workflows

2. Workflow Redesign & Automation

  • Color-coded A/R tracker with automated status labels
  • Standardized follow-up cadence (7–14–21–30 days)
  • Payer-specific escalation scripts and documentation templates
  • Eligibility and benefits verification workflow

3. Denial Management & Recovery

  • Corrected coding and documentation issues
  • Resubmitted claims with proper attachments
  • Appealed medical necessity and prior authorization denials
  • Implemented clean-claim workflow

4. Reporting & Transparency

  • Weekly dashboards
  • Denial trend analysis
  • Education on documentation and compliance
Results
  • 28% reduction in aged A/R (120+ days) within 60 days of onboarding
  • $52,000+ recovered from previously stalled claims within 45 days of onboarding
  • Clean claim rate increased to 98%
  • Provider gained full visibility into their revenue cycle
Why It Worked
  • Clear, repeatable workflows
  • Automated tools reducing human error
  • Consistent communication
  • Deep understanding of payer requirements

Case Study 2: Speech Pathology Credentialing Support

Client Background

A speech-language pathology (SLP) practice initiating insurance participation in Georgia and Virginia, facing credentialing challenges.

The Challenge
  • Incomplete or outdated CAQH profiles
  • Missing ASHA certification documentation
  • Documentation gaps
Our Approach

1. Credentialing Cleanup & Submission

  • Completed CAQH, NPI, and payer enrollment items
  • Ensured ASHA and liability insurance certification was properly uploaded
  • Submitted applications to commercial payers
  • Created a branded credentialing tracker with automated status updates

2. Workflow Standardization

  • Built payer-specific credentialing workflows
  • Created escalation scripts for credentialing follow-up

3. Reporting & Communication

  • Weekly credentialing updates
  • Clear visibility into requirements and next steps
Results
  • Credentialing turnaround time significantly reduced
  • Credentialing approvals within 30 days with some payers
  • Successful enrollment with commercial payers
  • Provider gained confidence in expanding insurance participation
Why It Worked
  • Therapy-specific credentialing expertise
  • Structured workflows replacing guesswork
  • Transparent communication and tracking

Case Study 3: Behavioral Health Revenue Cycle Optimization

Client Background

A multi-state, multi-provider behavioral health practice experiencing rising aged A/R, inconsistent documentation, and workflow disruptions caused by EMR technical issues. Leadership lacked visibility into revenue performance and needed a partner who could stabilize operations and restore predictable cash flow.

The Challenge
  • Aged A/R with claims sitting 90–180+ days
  • Coding errors related to recent behavioral health guideline updates
  • Frequent EMR glitches causing claim rejections and missing documentation
  • No eligibility verification process, leading to preventable denials
  • Limited transparency in reporting, leaving leadership unsure where revenue was leaking
  • Denials requiring medical records submission and structured appeals
Our Approach

1. Aged A/R Cleanup & Root-Cause Analysis

  • Stratified A/R by payer, age, and denial category
  • Identified systemic issues in documentation and coding
  • Prioritized high-risk claims for immediate follow-up
  • Rebuilt and resubmitted claims with corrected coding and attachments

2. Coding Corrections Based on Updated Guidelines

  • Reviewed recent CPT and behavioral health documentation changes
  • Corrected coding errors contributing to denials
  • Provided updated coding guidance to clinicians
  • Implemented a clean-claim workflow to prevent repeat issues

3. EMR Technical Support & Workflow Stabilization

  • Troubleshot EMR errors causing claim rejections
  • Coordinated with vendor tech support to resolve system bugs
  • Rebuilt templates and documentation fields to ensure required data populated correctly
  • Implemented internal checks to catch EMR-related issues before submission

4. Eligibility Verification Implementation

  • Added real-time eligibility checks to the front-end workflow
  • Created payer-specific benefit verification templates
  • Reduced downstream denials related to inactive coverage or authorization requirements

5. Denial Management & Appeals

  • Identified claims requiring medical records for appeal
  • Gathered and organized documentation for timely submission
  • Submitted structured appeals with supporting clinical notes
  • Tracked payer responses and escalated when necessary

6. Transparent Reporting for Leadership

  • Delivered monthly dashboards showing A/R movement, denial trends, and cash-flow impact
  • Provided clear explanations of payer behavior and systemic issues
  • Created a monthly executive summary for leadership decision-making
Results
  • 28% reduction in aged A/R (120+ days)
  • Significant decrease in coding-related denials
  • EMR-related claim rejections reduced by 80%
  • Eligibility-related denials nearly eliminated
  • Leadership gained full visibility into revenue cycle performance
Why It Worked
  • Deep understanding of behavioral health billing and coding
  • Ability to troubleshoot both operational and technical EMR issues
  • Clear, repeatable workflows replacing inconsistent processes
  • Transparent reporting that empowered leadership
  • Strong denial management and appeal strategy

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Asli C. MD
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Medical billing is very difficult unless you outsource... to do it in the office would take a lot more time and money. It has allowed me to get better reimbursement on my claims because I have an entire billing company behind me to check claims and follow up on them.

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