Family Medicine Denial Rate Reduction

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Where they started

A solo family medicine physician was spending 20 hours per week on billing. Collections were at 67% of charges. Within 90 days of switching to RCMBillers, both numbers changed dramatically.

The practice had been working with a previous billing company for years but had never received a detailed performance analysis. They had no visibility into their denial patterns, no escalation path for aged AR, and no one proactively identifying coding gaps or undercoded services.

What RCMBillers did

Completed a full revenue cycle audit in the first 30 days, identifying denial patterns and coding gaps.
Appealed all outstanding denials within filing deadlines — recovered previously written-off revenue.
Implemented front-end eligibility verification to stop denials at the source before claims were submitted.
Assigned a specialty-specific coder to review and correct documentation and coding protocols.
Set up a real-time dashboard so leadership could track KPIs daily without waiting for monthly reports.

Audit Everything

We reviewed 90 days of prior claims, identified every denial reason code, and mapped the coding accuracy across all providers. No assumptions — just data.

Step 1

Fix the Root Causes

Most denials came from 3 predictable sources. We fixed each one: eligibility verification timing, prior auth workflow, and modifier use. Denials stopped at the source.

Step 2

Measure & Report

Real-time dashboard from day one. Monthly executive report with KPI trends. Full transparency so leadership always knows exactly where revenue stands.

Step 3

Family Medicine Denial Rate Reduction