Turning Around Aged AR in 90 Days: A Multi-Specialty Case Study

Client Overview

A growing multi-specialty provider group based in the Southeast U.S., operating across internal medicine, cardiology, and neurology, was facing serious challenges with Accounts Receivable (AR) and staffing.

Practice Size: 7 providers, 3 locations
Payers: Medicare, BCBS, Aetna, UHC, Cigna
In-house billing team: Down from 5 members to 2 over 6 months
Monthly charges: ~$600K
EHR/PM: eClinicalWorks

The Problem

When the client reached out to AnnexMed, they were struggling to keep up with billing and follow-up.

We only got paid if they did. That model gave them confidence, but also pushed us to look deeper. Because for us to succeed, the entire revenue cycle had to be rebuilt.

Key Issues:

Overloaded team: Just two internal staff handling charge entry, claim submission, rejections, and follow-ups.
Rising backlog: Total AR had grown to $1.9M, with 41% aged over 90 days.
Denials unworked: Due to staffing, they couldn’t keep up with follow-ups, leading to multiple write-offs.
No payer insights: They lacked time and tools to analyze denial reasons or follow denial trends.
Delayed documentation: Specialists were submitting incomplete charts, which were often flagged during payer audits.

AnnexMed’s Solution

We proposed a 90-day AR turnaround plan, paired with staff augmentation to immediately address the workload gap.

Step 1: Initial Review (Days 1–10)

Pulled an aging report for all claims >60 days.
Reviewed 1,000+ claims in detail across all specialties.
Categorized claims by:
1. Denial reason (e.g., coding, documentation, authorization)
2. Payer (with focus on Medicare Advantage and BCBS)
3. Timely filing risk
Identified that cardiology and neurology were the highest contributors to unpaid AR.

Step 2: Team Deployment & Prioritization (Days 11–60)

Assigned 3 full-time AR callers and 1 certified coder trained in multi-specialty RCM.
Set up a shared claim status tracker, integrated with the client’s PM system.
Prioritized:
1. Claims >90 days
2. Claims nearing timely filing deadlines
3. Denials with appeal opportunities
Created payers’ cheat sheets for quicker appeal documentation.
Worked daily with internal team to avoid duplicate efforts.

Step 3: Root Cause Fixes & Reporting (Days 61–90)

Introduced a weekly denial summary report with top denial codes per specialty.
Worked with providers to:
1. Improve clinical documentation
2. Correct coding errors (especially neurology-specific EM and diagnostic codes)
Reduced rework by adjusting charge entry rules and modifier usage for common scenarios.
Coached internal staff on appeal best practices.

Final Outcomes (After 90 Days)

Metric	Before AnnexMed	After 90 Days
Total AR	$1.9M	$980K
AR > 90 Days	41%	15%
Denial Rate	14%	5.2%
Clean Claim Rate	76%	93%
Monthly Collections	$410K	$615K
Appeal Success Rate	~40%	78%