Case Studies

A realistic example of what a billing stabilization looks like

Below is an illustrative example based on common clinic workflows. Actual results vary by payer mix, documentation quality, and current operations. The goal here is to show what we do, how we measure it, and what changes first.

Example clinic

Multi‑provider urgent care (2 locations)

Monthly volume: ~2,800 visits
Payer mix: Commercial + Medicaid + self-pay
Tools: EHR/PM + clearinghouse
Main issue: preventable denials + slow AR follow-up

Starting problems

What we found in discovery

Front-desk insurance capture inconsistent → missing subscriber fields
No standard charge/claim checklist → avoidable rejections
Denial categories not tracked consistently → same issues repeating
AR follow-up had no clear queue ownership

What we implemented (first 30 days)

SOPs + QA + reporting (the trust stack)

SOP

Clean-claim checklist

Required fields checklist + payer-specific validation before submission.

QA sampling

Daily samples for common error types + immediate feedback loop.

KPI

Weekly KPI report

Denials by category, AR movement, top blockers, next actions.

Illustrative outcomes

What improved first (4–8 weeks)

Claim rejection rate8.2% → 3.4%*

Denials tied to eligibilityDown ~28%*

AR > 60 daysDown ~17%*

Staff interruptionsReduced via queues*

*Illustrative example — for expectation-setting only. Targets are agreed during discovery and tracked weekly.

Why it worked

Not “hard work” — structure

Fewer repeats: root-cause fixes prevent recurring denial types
Clear ownership: each queue has an owner and an escalation path
Visible progress: weekly KPIs create accountability and trust

Request a denial snapshot See our process

Want us to build this for your clinic?

We’ll start with a quick discovery and propose a pilot scope + the KPIs we will report weekly.

Get Free Snapshot