Case Studies

Real problems, measurable results

How Med Revenue System turns operational drag into revenue, speed, and peace of mind — across healthcare and beyond.

98%

Clean claim rate

30%

Average revenue lift

24/7

Operations coverage

HIPAA

Compliant processes

Success Stories

Engagements that moved the numbers

Each story below is a representative, anonymized engagement — a real problem, what our team did, and the outcome it produced.

Healthcare · Multi-specialtyRevenue Cycle Management

Cutting denials by two-thirds and freeing trapped A/R for a multi-specialty group

A 22-provider multi-specialty physician group in the Southeast (primary care, cardiology, orthopedics, and GI)

97%

First-pass clean claim rate (up from 82%)

-64%

Reduction in claim denials over 9 months

34 days

Days in A/R (down from 58)

+29%

Net collections lift

The challenge

The group was losing revenue to a rising denial rate and a backlog of aged claims, with more than a third of its A/R sitting past 90 days. A thin in-house billing team was working reactively — reworking denials one at a time without addressing root causes — so clean claim rates hovered in the low 80s and cash flow stayed unpredictable across specialties.

What we did

Ran a full RCM audit across all four specialties to categorize denials by payer, CARC/RARC code, and root cause, then prioritized the highest-dollar and highest-volume drivers
Deployed certified coders (ICD-10/CPT/HCPCS) and front-end claim scrubbing to catch eligibility, coding, and demographic errors before submission
Stood up a dedicated denial-management and appeals workflow with payer-specific playbooks, so denials were worked in batches by cause rather than one-off
Launched a structured aged-A/R cleanup on the 90+ day backlog, sequencing accounts by recoverability and timely-filing deadlines
Added weekly KPI reporting (clean claim rate, denial rate, days in A/R, net collections) with a 24/7 team feeding trends back into front-end edits

We were drowning in denials and honestly didn't know where the money was leaking. Within a couple of months we could see exactly which payers and codes were costing us, and the aged claims we'd written off in our heads started turning into deposits. The weekly numbers keep everyone honest.

Rebecca T. — Revenue Cycle Director, multi-specialty physician group

Healthcare · CardiologyMedical Billing & Coding — certified specialty coding and audit support

Lifting a cardiology practice to a 98% coding audit pass rate

An 11-provider single-specialty cardiology practice in the Midwest, with an on-site cath lab and electrophysiology service line

98%

Coding audit pass rate on external review

-44%

Coding-related claim denials

97%

First-pass clean claim rate

+22%

Net collections (representative)

The challenge

The practice was seeing a steady rise in coding-related denials tied to interventional and EP procedure coding, E/M level assignment, and modifier use (notably -25 and -59). After receiving a payer audit notice, leadership was concerned about both lost revenue and compliance exposure. Their small in-house team lacked dedicated cardiovascular coding depth and a consistent pre-submission review process.

What we did

Assigned a dedicated pod of AAPC/AHIMA-certified coders with cardiology-specific experience across ICD-10, CPT, and HCPCS, including cath lab, EP, and device procedures
Ran a baseline retrospective audit on a representative sample of encounters to quantify error patterns and prioritize the highest-risk code sets and modifiers
Built cardiology-specific coding guidelines and payer-rule checklists, and added a mandatory second-level QA review before claim submission
Created a documentation feedback loop with physicians to strengthen specificity and medical-necessity support without slowing the clinic
Instituted monthly internal audits with error trending and a compliance report to management, so accuracy gains held over time

The audit notice was a wake-up call. Having certified cardiology coders and a real second review before claims go out changed everything — our denials dropped, and we walked into our external audit confident instead of nervous.

Karen M. — Practice Manager, single-specialty cardiology group

Healthcare · DME / Prior AuthorizationEligibility & Prior Authorization

Cutting auth-related denials by 71% for a regional DME supplier

A regional durable medical equipment (DME) supplier processing roughly 2,800 orders a month across the Upper Midwest

-71%

Reduction in auth-related claim denials within four months

Under 4 hrs

Average verification turnaround, down from 2-3 business days

32 hrs/week

Front-office staff hours freed from manual verification

~98%

Clean claim rate on authorization-dependent orders

The challenge

The supplier was writing off a growing share of revenue to preventable, auth-related denials, with prior authorizations often taking two to three business days to initiate because a small front-office team was verifying benefits manually between phone calls. Delayed and incomplete authorizations stalled equipment delivery, frustrated referring providers, and left aging claims stuck in a rework queue. Leadership needed faster, cleaner verification without adding headcount.

What we did

Deployed a dedicated eligibility and prior-authorization team to verify benefits and DME coverage criteria before each order was scheduled, working payer portals and phone queues during extended hours to clear same-day requests
Built payer-specific auth checklists and documentation templates for high-volume equipment categories so submissions went out complete on the first attempt
Instituted real-time eligibility checks at intake to catch inactive coverage, plan changes, and medical-necessity gaps before delivery
Added proactive tracking of pending authorizations with status follow-up and expiration alerts to prevent lapsed approvals
Set up a weekly denial-root-cause review and shared reporting so recurring payer issues were fixed at the source rather than reworked downstream

Prior auth used to be the bottleneck that held up every delivery. Now verifications come back the same day, our denials have dropped off a cliff, and my team finally has time to focus on patients instead of chasing payer portals.

Danielle R. — Operations Manager, regional DME supplier

Insurance · P&C CarrierOperations & Finance — Back Office & Data Entry

Clearing a document backlog and freeing 3 FTEs for a mid-market P&C carrier

A mid-market commercial property & casualty insurance carrier (~250 employees) in the Midwest

99.6%

QA-audited data entry accuracy across processed documents

6 hrs

Average document turnaround, down from 24+ hrs

-38%

Document processing cost vs. prior in-house baseline

3 FTEs

Underwriting/claims staff freed for higher-value work

The challenge

The carrier's operations team was manually keying policy applications, endorsements, and first-notice-of-loss claims documents into its policy admin system, and a growing submission volume had pushed turnaround past 24 hours with a persistent backlog. Licensed underwriters and adjusters were spending hours on data entry instead of risk and claims work, and inconsistent keying was driving downstream rework and correction cycles.

What we did

Stood up a dedicated back-office team trained on the carrier's policy administration and document-management platforms and its document-type taxonomy
Rebuilt intake into a standardized keying workflow with dual-key verification on high-value documents and daily QA sampling against a defined accuracy standard
Introduced tiered SLAs with a same-day queue for time-sensitive endorsements and FNOL claims intake
Added daily exception and aging reports plus a QA feedback loop so errors were caught and corrected at the source rather than downstream
Ran extended, overlapping shifts to clear the existing backlog while keeping pace with incoming daily volume

We were drowning in paperwork and pulling underwriters off real work just to keep up. Med Revenue System cleared the backlog within the first few weeks, and the accuracy has been consistent enough that we stopped double-checking every batch. It quietly gave us three people back.

Diane M. — VP of Operations, mid-market P&C insurance carrier

Client names and identifying details are withheld under non-disclosure agreement. Case studies are representative of typical engagements; specific results vary by practice, payer mix, and baseline.

In Their Words

What clients say about working with us

“Our clean claim rate climbed to about 98% within two quarters, and A/R days dropped from the mid-50s to the low 30s. The denials that used to pile up on Fridays just aren't there anymore.”

Rachel B.

Practice Manager, multi-site dermatology group in the Southeast

“Med Revenue System's certified coders cleaned up our ICD-10 and CPT accuracy on some genuinely complex cases, and our first-pass acceptance went up noticeably. We caught roughly a 25% lift in collected revenue over the year, mostly from stopping preventable rejections.”

Daniel M.

Revenue Cycle Director, 14-provider orthopedic practice in the Midwest

“They took over eligibility checks and prior auths for us, and the back-and-forth with payers that used to eat our front desk's whole morning is now handled before the patient walks in. Auth-related delays are down and our staff can actually focus on patients.”

Priya S.

Office Administrator, regional cardiology group in the Northwest

“We handed off claims data entry and back-office reconciliation that was quietly falling behind, and the backlog cleared inside a month. Accuracy on the files we spot-check has been consistently strong.”

Angela R.

Back Office Supervisor, mid-size property and casualty insurer

“Med Revenue System runs our after-hours patient support line and it feels like part of our own team. Call abandonment dropped sharply and patients tell us they finally reach a real person at 11pm.”

Sofia H.

Patient Services Lead, multi-specialty clinic network in the Southwest

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