When this 12-clinician group therapy practice audited their revenue cycle at the start of the year, they found $8,000 in leakage every month — denials that were never worked, E/M codes that were chronically under-billed, and secondary claims that never went out.
The baseline: where the leak was
Their billing manager was also the office manager. She was good — but she had 11 other jobs. First-pass acceptance hovered at 82%, days in A-R were creeping past 60, and 18% of denials were being written off without appeal.
Month 1: eligibility and intake
Real-time eligibility checks at booking and again at check-in. Superbill validation against documentation before submission. Denial rate dropped 40% in the first six weeks.
Month 3: aggressive A-R work
A dedicated A-R specialist worked every claim over 30 days weekly. Aged claims over 120 days were appealed or escalated. Collections on “lost” claims recovered $18,000 in a single quarter.
Month 6: specialty coding review
A CPC-certified behavioral-health coder reviewed 90 days of sessions. Chronic under-coding on 90837 (versus 90834) added 4% to per-session revenue going forward — the single largest line-item gain.
What the clinicians noticed
Not the money. The time. Front-desk staff stopped fielding insurance questions. Clinicians stopped writing notes at 10 p.m. The practice owner took her first week off in three years.