Heritage Family Medicine: 32% Revenue Increase in 90 Days
How a busy family practice transformed their revenue cycle by addressing denial patterns and streamlining their billing processes.
Practice Overview
The Challenge
Heritage Family Medicine was struggling with mounting claim denials and slow payments. Their internal billing team of 3 staff members was overwhelmed, leading to:
- High denial rates: 12.4% of claims were being denied, well above industry average
- Slow collections: Average 47 days in AR was impacting cash flow
- Missed revenue: Wellness visits and chronic care management were under-billed
- Staff burnout: Billing team spent most time on denials rather than prevention
Baseline Performance
Our Solution
Week 1-2: Comprehensive Audit
We analyzed 6 months of billing data and identified the top denial reasons: missing prior authorizations (31%), incorrect wellness visit coding (24%), and inadequate chronic care management documentation (18%).
Week 3-4: Process Implementation
We implemented real-time eligibility verification, created wellness visit coding templates, and established CCM enrollment workflows. Provider education sessions ensured proper documentation.
Week 5-8: Active Management
Our team took over all claim submission and denial management while implementing systematic follow-up processes for aging accounts receivable.
Week 9-12: Optimization
We refined processes based on initial results, expanded CCM billing to eligible patients, and implemented automated denial pattern reporting to prevent future issues.
Results After 90 Days
Key Achievements:
- • $78,000 additional monthly revenue from improved collections
- • $18,500 new monthly revenue from CCM billing implementation
- • 74% reduction in claim denials
- • 49% improvement in cash flow (AR days reduced by 23 days)
- • Practice staff redirected from billing to patient care activities
"The transformation has been remarkable. We're seeing consistent cash flow for the first time in years, and our staff can finally focus on patients instead of insurance problems. The CCM revenue alone paid for the billing service within the first month."— Dr. Sarah Martinez, Heritage Family Medicine
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