RCM Turnaround Restores $4.2M

What We Saw at the Start

A multi-specialty physician group in the southeastern United States, with more than 45 providers across primary care, orthopedics, and cardiology, was in a period of rapid expansion. Over 18 months, the group strengthened its network by acquiring three independent practices. The acquisition promised more revenue and efficiency. However, reality quickly resulted in the opposite, disrupting cash flow and billing accuracy. Through a phased RCM intervention, the group recovered lost revenue, improved AR metrics, and rebuilt financial trust with leadership and providers.

The Promise vs. The Reality

Multi-specialty providers often inherit complex AR portfolios with mixed collectability and compliance risks. This client’s legacy receivables presented multiple operational hurdles that threatened both cash flow and regulatory standing. Each challenge required careful attention to avoid costly errors during the liquidation process.

Hidden Challenges Uncovered

Fragmented Payer Contracts

Each acquired practice kept its original fee schedules, some over 7 years old. Contracts had not been updated under the group’s tax ID after acquisition. Payers reimbursed at outdated rates, causing underpayments averaging 7–12%.

Credentialing Roadblocks

New physicians were not fully credentialed under group payer contracts. Claims faced denials such as CO-18 and N95. Providers waited 90–120 days for credentialing, leading to claim delays or write-offs.

System Inconsistencies

With eCW & Allscripts used in acquired sites & NextGen at the group level, coding templates & charge capture were fragmented. Modifier errors in Allscripts caused denials unseen in NextGen, exposing inconsistent revenue.

Legacy AR Burden

Inherited $8.7 million unresolved AR backlog came with 61% over 180 days old. Lack of consolidated reporting made it impossible to separate collectible claims from old, uncollectible balances.

AnnexMed’s Three-Phase Recovery Framework

Phase 1: Stem the Revenue Loss (0–90 Days)

AnnexMed consolidated all payer contracts under the group’s tax ID, updated fee schedules, and deployed variance tools to track underpayments. A dedicated credentialing team accelerated enrollments and enforced a no-scheduling-without-credentialing rule. Shadow coding audits across all systems uncovered 18% claim errors, mainly modifiers and bundling, which were corrected before submission.

Phase 2: Untangle Legacy AR (90–180 Days)

The team segmented legacy AR by payer, age, and balance size to target recovery. Small balances were written off under CFO guidance, while high-value claims received direct payer follow-up. Commercial accounts were prioritized, and Medicaid crossover errors were corrected. Medicare and Medicaid claims were reconciled with LCD/NCD updates to ensure compliance and accuracy.

Phase 3: Build Sustainable Scale (180–270 Days)

AnnexMed unified all acquired practices under NextGen for consistent charge capture and reporting. Coding templates were standardized across specialties, and payer-specific denial dashboards provided real-time visibility. Quarterly contract compliance audits were launched, giving the CFO actionable variance reports and establishing a continuous feedback loop to maintain financial control and operational consistency.

Driving Financial Recovery Through Control and Clarity

AR was segmented by payer, practice, and balance size to prioritize high-yield recovery efforts.
High-value claims above $15K were escalated through dedicated payer worklists to accelerate resolution.
CFO-approved write-off thresholds and quarterly variance reports strengthened accountability and financial transparency.
Unified payer contracts and updated fee schedules ensured accurate reimbursements and eliminated outdated rates.
Streamlined credentialing workflows reduced onboarding delays and closed recurring payment gaps.
EHR consolidation into NextGen standardized charge capture and minimized coding inconsistencies across sites.
Real-time contract variance tracking and shadow coding audits improved claim accuracy and prevented underpayment leakage.
Regular compliance reviews maintained consistent financial performance and positioned the group for stronger payer negotiations.

Solution Impact

$4.2M

Identified & Recovered from inherited AR

$1.1M

Recovered in underpayments

32%

Drop in Denials & Credentialing stabilized

40%

Drop in patient billing complaints

Ready to Get Started?

Whether you need full-scale support or help with just one part of the revenue cycle, AnnexMed offers modular services tailored to your most pressing needs.

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