Results · Case Studies
Situation, what was found, what changed, timeframe, and dollars where possible. Real clients with permission, or anonymized by specialty and size. Anything illustrative is labeled as such.
This practice is building its client base. What follows describes capability grounded in more than two decades of hospital billing, claims adjudication, coding, payer contract analysis, and reimbursement work not completed engagements through this firm. As engagements complete and clients consent, results will be published here with real numbers.
Internal Medicine · 4 providers · Southeast
Situation
A/R aging had been climbing for three quarters. The practice was busy, collections were flat, and nobody could explain why.
What was found
A commercial payer had been paying 18% below contracted rate on five high-volume E/M codes for 14 months. Credentialing for one provider had lapsed, silently denying claims for 60 days.
What changed
Underpayment demand recovered $112,000. Credentialing reinstated. Contract-rate variance monitoring added to the monthly billing cycle.
Timeframe
Recovery within 45 days of engagement
Dollars
$112,000 recovered
Nurse Practitioner Practice · Solo · Midwest
Situation
New NP practice, six months in, collections well below pro forma.
What was found
The 85% Medicare reimbursement had not been modeled in the pro forma. Incident-to billing was being used without meeting supervision conditions an audit exposure. Three commercial payers had not yet credentialed the NP.
What changed
Pro forma rebuilt with accurate reimbursement. Incident-to use corrected. Three payer enrollments completed. Monthly reporting established.
Timeframe
Credentialing completed in 90 days
Dollars
Pro forma gap closed; audit risk eliminated
Multi-specialty Group · 8 providers · South
ILLUSTRATIVESituation
Denial rate above 11%. Staff working denials reactively with no prioritization.
What was found
70% of denied dollars sat in three denial codes. Timely filing had closed on $34,000. No contract-rate checking existed.
What changed
Denial work prioritized by dollar value and appeal deadline. Root-cause fixes applied to the three repeatable denial codes. Denial rate dropped to 4.2% within four months.
Timeframe
4 months to sub-5% denial rate
Dollars
$34,000 lost to timely filing; $87,000 annualized recovery going forward
The FTC's 2024 Rule on the Use of Consumer Reviews and Testimonials prohibits fake or misrepresented testimonials and undisclosed insider reviews. These case studies are real clients with permission, or anonymized by specialty and size. Results are not typical and depend on the client's circumstances, the condition of records, and the payer environment.
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