When the two-provider gastroenterology practice first approached us, they weren’t looking for an RCM vendor.
They were looking for answers.
They didn’t know what was being billed.
They didn’t know what had been collected.
They didn’t even know what needed to be collected.
The Hidden Cost of Unseen Revenue
- The practice had no idea what claims were worth, what was collected, or what was still pending.
- Their in-house biller had quit, and a temporary staff member was manually handling billing tasks.
- There was no structured process for charge capture, eligibility, or denial management.
- Old AR was untouched, and no one tracked how much was aging out.
- No KPIs, no reports, no insights, just a growing sense that revenue was slipping through the cracks.
What We Found
Our first engagement wasn’t complex. They just wanted us to “take a look” and tell them what we see.We requested access to their practice management system and clearinghouse. Within the first 72 hours, we spotted:
- High-dollar procedures with no claims ever filed
- Claims submitted with incorrect or missing modifiers, common in GI coding
- Eligibility issues that were leading to preventable denials
- Claims rejections sitting unaddressed for 60+ days
- A complete lack of claim-to-payment mapping, no one knew what a $1,000 procedure had actually fetched in reimbursement
Full Ownership, No Loose End
Instead of fixing one piece, we took over the entire revenue cycle under a transparent percentage-of-collections model. Here’s what changed:
- Eligibility & Benefits – Daily verifications were established for all scheduled patients. We flagged coverage gaps and pre-auth requirements before the patient even arrived.
- Specialty GI Coding – Our AAPC-certified coders reviewed every procedure. Common oversights like missing modifiers (e.g., 51, 59, 26) and undercoded scopes were corrected. The result? Fewer denials and optimized reimbursements.
- Charge Entry & Claim Submission – We mapped each provider’s daily notes to charges. Claims went out within 24 hours, with a second layer of review to ensure clean submission.
- Accounts Receivable Follow-Up – Our AR team segmented aging buckets and tackled >90-day claims first. We categorized denials, filed appeals, and established a weekly report to the client outlining payer responses and trends.
- Performance Visibility – For the first time ever, the practice had a live KPI snapshot:
- Total charges billed
- Total collected
- Outstanding AR (by age & payer)
- Denials (by category)
- Average reimbursement per CPT code
The Outcome: Confidence in the Numbers
In just 120 days, the practice saw a complete turnaround:
- Clean claims rate improved to 92%
- Denials dropped by 36%, most resolved at the root (coding and eligibility)
- $54,000 in old AR was recovered, amounts they didn’t even know were stuck
- Collections increased by 20% without adding more patients or services
- Weekly cash flow became predictable
- For the first time, the physicians understood how much each procedure was worth, how much they actually received, and what was still pending
We rebuilt their revenue cycle with structure, visibility, and accountability.
No surprises. No jargons. Just consistent results, backed by a committed team and real-time reporting.
