The challenge
The clinic had grown quickly, adding specialties and doctors while its billing team and processes stayed the same. Patient volumes were healthy, yet collections did not keep pace. Rejections from several insurers and third-party administrators were rising, receivables were ageing, and the owners could not tell which departments, payers or habits were responsible.
Much of the problem started long before a claim was submitted. Eligibility was not always checked at the front desk, pre-authorisations were requested late or not at all, and clinical notes did not consistently support the codes billed. The small billing team spent its time resubmitting claims and had little capacity to find and fix the root causes.
Our approach
Revenue cycle diagnostic
We traced a sample of claims from appointment to remittance, reviewed rejection reasons by payer and specialty, and interviewed front desk, doctors and billing staff to see where information was being lost.
Front-end controls
We introduced a simple eligibility and pre-authorisation checklist at registration, clarified which services needed approval for each payer, and set clear handover points between reception, doctors and billing.
Documentation and coding review
We worked with doctors on the documentation each payer expected, reviewed coding patterns in the specialties with the most rejections, and set up a light pre-submission check for high-risk claims.
Denial management routine
We built a weekly denial review that grouped rejections by reason, assigned owners and tracked appeals to closure, with a short report the owners could read in a few minutes.
The outcome
Claims now leave the clinic in better shape. Front desk staff check eligibility and approvals as a matter of routine, doctors understand what each payer needs to see in the notes, and the billing team spends more of its time on genuine exceptions rather than repeating the same corrections.
Just as importantly, the owners can see what is happening. Rejection reasons are visible by payer and specialty, appeals are followed through, and the team runs the weekly review without outside help. The clinic now has a revenue cycle that can absorb further growth without collections falling behind again.