Issue/opportunity

A community-based health system with 600+employed providers was facing serious revenue leakage:

• Billing inaccuracies (ED visits coded as urgent care regardless of time of day).
• Missed365-day rebilling windows, resulting in millions in uncollected claims.
• Decentralized RCM operations split between clinics and hospital departments with no unified accountability.
• High claim denial rates due to documentation gaps and inconsistent charge capture.
• Leadership lacked visibility into root causes and had no standardized governance model to sustain improvement.

Approach & outcomes

• Revenue Cycle Diagnostic: Conducted a 90-day deep dive across registration, coding, billing, and denial management functions to quantify leakage.
• Charge Capture Redesign: Mapped workflows end-to-end to eliminate coding errors and introduced automated claim validation rules.
• Workforce & Accountability Model: Created a centralized RCM command center and clarified ownership between front-end, mid-cycle, and back-end teams.
• Technology & Analytics Integration: Implemented KPI dashboards tracking daily denial trends, rebill deadlines, and payer response times.
• Compliance Reinforcement: Introduced continuous CDI audits and physician documentation training to prevent recurrence.

Results

• Recovered $42M in missed billing opportunities within 12 months.
• Reduced denial rate by 38% through process standardization.
• Shortened A/R days by 21% and improved net collection rate by 8 points.
• Prevented future losses by institutionalizing rebill tracking and audit triggers for all high-volume service lines.