We recently helped a Louisiana family medicine practice fix their billing process.
- They increased monthly collections from $90,000 to $114,000. This 27% improvement has been sustained month after month.
- Clearing their backlog of outstanding claims gave a rapid cash boost of $40,000.
- 98% of claims now get paid on the first pass, no rejections or rework needed.
Background
This 4-physician practice in Lafayette, Louisiana offered support for general health concerns and chronic conditions (like diabetes and high blood pressure). They brought a strong community focus and dedication to patient care, spending significant time with each individual. Patients were loyal as a result. Several patients had been under the provider’s care for more than 8 years.
Main Challenges
When this practice first contacted us, they were frustrated at the poor support from their previous billing company. Lack of cash-flow created constant problems. Despite their full schedule and quality care, they were only collecting $90,000 per month, well below what similar practices in their area would expect.
Much of their revenue was getting lost to billing errors and inefficiencies. The practice faced constant denials. Yet the billing company couldn’t explain rejection reasons or provide guidance on preventing them. Besides crippling their collections revenue, the high denial rates also meant endless rework and frequent audits.
The stress was taking a toll on everyone, from the physicians to the office staff. Overwork led to high staff turnover. People would learn the job, get overwhelmed by the chaos, and quit – forcing the practice to start over with new hires. The staff worked in fear that their billing problems would damage the patient relationships they’d worked for years to build.
Discovery and Insights
We began with a detailed assessment of their revenue cycle. We analyzed their billing reports, claims history, denial patterns, and EMR data to map out where revenue was falling through the cracks.
1. Billing was erratic. Some revenue was coming in, but the process was inconsistent. Instead of a standard 1-2 days, claims took over 21 days to submit, creating cash flow problems that compounded monthly. Our review also uncovered that 80% of claims were stuck in their system with unresolved errors, never making it to insurance companies. Their billing company offered no explanation for this lapse.
2. Claims weren’t submitted properly. Even when claims did go out, they were inaccurate or had incomplete documentation. The practice spent hours fixing errors that should never have happened in the first place. Insurance payers frequently demanded audits, which meant hours of extra work and a risk of compliance penalties.
3. No insurance verification. We found no one was checking insurance eligibility before visits. Patients received treatment, claims were submitted three weeks later, and only then did anyone discover the patient wasn’t covered. As a result of this issue, incorrect documentation, and other preventable mistakes, 1 out of every 5 claims was getting denied.
The practice also faced a lack of communication from their billers. The old billing company mostly operated in isolation, not sharing insights about denial trends or payer policy changes. They rarely provided reports on accounts receivable, feedback on documentation quality, or support for improving processes.
The practice could tell things weren’t right with their billing. But they never had the data (or time to get that data) to prove it.
Our Impact
After partnering on the practice’s billing operations, we helped them rebuild their revenue cycle.
First, we eliminated the billing backlog. Our team cleared months of unprocessed claims. We trained their staff on catching and fixing common mistakes before submission, speeding up payments. And we restarted sending out patient statements, which had been on hold for months. Now all payment requests go out like clockwork, cutting claim submission time from 21 days to under 24 hours.
We fixed the documentation and denial problems. We provide a dedicated medical scribe who reviews documentation daily, helps providers fix issues, and ensures each note meets insurance requirements. We also provide a full-time eligibility specialist who confirms every patient’s insurance coverage before their appointment. Documentation-related denials? Way down. Denials for coverage issues? Near zero.
We eased the burden on practice staff. We provide a virtual administrative assistant who takes on routine tasks like insurance verification calls and claim follow-ups. We simplified the practice workflows, replacing chaotic processes with clear, repeatable systems. Turnover dropped. Staff who once dreaded coming to work now feel supported and empowered.
Finally, we established regular communication. We set up twice-weekly check-ins to tackle immediate issues, weekly financial reviews to track progress, and monthly strategy meetings to plan for growth. The practice now knows exactly where every claim stands, and we address problems before they spiral.
The total result?
In our first few weeks, we helped them clear the backlog and bring in more than $130,000 – the highest collection month in their history. They’ve sustained strong billing, collecting an extra $24,000+ each month compared to before. And they’re now getting paid appropriately for the exceptional care they provide.
Beyond the Numbers
Today, providers spend their time on patient care instead of fielding documentation complaints. The office runs smoothly with staff who want to stay. And patients appreciate the new proactive approach, with timely reminders and clear communication about their coverage.
The practice is even considering expanding their treatment and offering new services. As the owner told us on one of our weekly calls, “We are lucky to have found you; now we can focus on the practice and patients, without being stressed by administrative hassles.”
Let’s Create Similar Results for Your Practice
If you’re struggling with declining collections, too many denials, or challenges with cash flow, we can help. Schedule a free revenue cycle assessment today. We’ll show you exactly where your money is getting stuck, and how to fix it.