Case Studies / Revenue Cycle
$4.2M recovered. Days in A/R reduced from 58 to 34.
An 85-provider multi-specialty physician group was experiencing revenue cycle deterioration. Days in A/R had increased to 58. Denial rates exceeded 18%. The previous billing vendor had been terminated. The organization needed immediate stabilization and long-term process improvement.
The physician group had outsourced revenue cycle management to a national billing company. Performance declined gradually over three years. When the relationship ended, the group inherited a backlog of 4,200 unpaid claims, incomplete credentialing files, and no documented processes.
Cash flow was strained. The group was deferring equipment purchases and delaying new hires. Several payers had escalated the organization to high-denial status, triggering additional claim scrutiny. The financial situation was affecting clinical operations.
Internal staff had limited revenue cycle experience. The practice manager had clinical background but no billing expertise. Building an in-house team from scratch would take months the organization did not have.
TNG deployed an RCM team that assumed full revenue cycle operations within 30 days. The engagement combined immediate stabilization with systematic process improvement.
The initial backlog required aggressive recovery efforts. TNG coders reviewed each claim for coding accuracy before resubmission. Appeals included clinical documentation demonstrating medical necessity. Payer relationships were rebuilt through direct outreach.
The $4.2M recovery came from three sources: aged claim resolution ($2.1M), denial overturn ($1.4M), and underpayment identification ($0.7M). Cash flow stabilized within 90 days. The organization resumed deferred capital investments.
Days in A/R decreased from 58 to 34—below the industry benchmark of 40. Denial rates dropped from 18% to 8% through front-end improvements that prevented denials rather than appealing them after the fact. Clean claim rate reached 96%.
The engagement was structured with transition in mind. TNG documented all processes, trained internal staff, and transferred operations systematically. By month 12, the group operated revenue cycle functions internally with TNG providing oversight and complex claim support.
The organization now employs a revenue cycle manager and three billing specialists. TNG continues to provide coding services and denial management for complex cases. The hybrid model maintains expertise while controlling costs.
"We were in a crisis when TNG came in. Within 90 days, we had cash flow again. Within a year, we had a functioning revenue cycle operation. The recovery paid for the engagement several times over."
Multi-Specialty Physician Group
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