RCM Case Study: 63% Denial Reduction, Multi-Specialty Practice
How Medical Billers and Coders achieved $1.13M+ in billed revenue, drove monthly denial dollars from $209K to $78K, and delivered 98.88% charge lag efficiency for a multi-specialty outpatient practice in just 4 months.
Who MBC worked with and what was engaged.
Four revenue problems MBC was brought in to fix.
Uncontrolled Denial Volume
Monthly denial dollars reached $209,000 by January 2026, with no structured root-cause analysis or re-submission workflow. Revenue was leaving through high-volume, repeating denial codes that went unaddressed.
No Charge Lag Monitoring
Without a defined charge submission timeline, delayed billing created a compounding revenue gap. Every day a charge sat unbilled increased the risk of timely filing denials and reduced net collections.
Patient Responsibility at 26%
Self-pay and patient balance exposure stood at 26% of total charges in January, straining collections and tying up follow-up bandwidth. No structured patient responsibility workflow was in operation.
Limited Cross-Payer Visibility
With a complex payer mix spanning BCBS, Medicaid, Medicare, Aetna, Cigna, and self-pay, the practice had no payer-wise AR distribution or denial trend reporting to guide financial decisions.
MBC's Revenue Cycle Management Approach: Five Priorities, Executed Simultaneously
MBC deployed an integrated, end-to-end RCM strategy across both service lines from day one, sequenced to close revenue gaps in order of financial impact. Click any step to expand.
MBC implemented a charge submission standard requiring all claims to be filed within 0 to 7 days of service, with workflows built for both service lines including ketamine infusion encounters. Result: 98.88% of all $1,136,026 in billed charges submitted within the defined window, eliminating timely filing exposure.
MBC catalogued 14,747 denial instances totaling $633,955, then stratified them by code, payer, and visit type. The top five denial codes (CO-23, CO-16, CO-167, CO-133, CO-22) each received dedicated resolution protocols with payer-specific re-submission logic. BCBS, accounting for $400K+ of total denial volume, received a dedicated appeal and corrective billing track.
A dedicated patient balance follow-up workflow was introduced to reduce the 26% patient responsibility exposure. Through systematic outreach and structured payment recovery, $200K in self-pay payments were collected over the engagement. By April 2026, the patient responsibility rate was reduced from 26% to 18%.
MBC established a structured AR monitoring framework tracking distribution by payer and aging bucket. Total AR balance was maintained at $219,228, with AR aged beyond 90 days controlled at just $23,260, well below industry benchmarks. The 0 to 30 day bucket held the largest concentration ($150,000+), confirming active and timely follow-up across all payers.
MBC delivered month-wise reporting on billed charges, payment rates, denial trends, encounter status, and AR aging. Practice leadership gained complete visibility into revenue performance by payer and visit type, enabling data-driven decisions on staffing, scheduling, and payer contract evaluation.
Medical Billing Results: What 4 Months of End-to-End RCM Delivered
All metrics span January 2026 through April 2026 across both practice service lines.
Denial Dollar Trend — January to April 2026
63% reduction in monthly denial dollars over 4 months of structured denial management.
63% drop. Primary denying payer: BCBS ($400K+ addressed). Total denial instances: 14,747 across $633,955.
Payer Mix Distribution
Breakdown by billed charge volume across all 4 months.
AR Aging Bucket Distribution
End-of-engagement AR profile. Current bucket dominance confirms active follow-up.
AR >90 days held at $23,260 out of $219,228 total. Payer-wise AR: BCBS 41.07%, Self-Pay 16.38%, Medicare 14.23%.
Encounter Volume by Visit Type
Total patient encounters processed across all visit types over the 4-month engagement.
Monthly Billed Charges vs. Patient Responsibility Rate
Billed charge volume held steady while MBC drove patient responsibility down from 26% to 18%.
Within 4 months, this practice saw a dramatic turnaround in denial management, a near-perfect charge submission timeline, and a healthier AR profile, powered entirely by MBC's end-to-end revenue cycle expertise.
Denial Management Resolution: Top CARC Codes Identified and Corrected
MBC catalogued 14,747 denial instances totaling $633,955 across 4 months, then assigned targeted resolution workflows to each top denial reason code.
| Code | Description | Primary Payer | MBC Resolution Approach | Status |
|---|---|---|---|---|
| CO-23 | Charge submitted to incorrect payer; coordination of benefits error | BCBS, Medicaid | COB verification workflow; payer hierarchy correction at intake | Resolved |
| CO-16 | Claim lacks information; required documentation missing or incomplete | BCBS, Medicare | Documentation checklist at charge capture; front-end validation added | Resolved |
| CO-167 | Diagnosis not covered; code does not support medical necessity | Medicaid, BCBS | Diagnosis-to-procedure alignment audit; coder-provider communication loop established | Resolved |
| CO-133 | Claim submitted without required modifier or with incorrect modifier | BCBS, Commercial | Modifier audit applied to all procedure codes; payer-specific rules embedded in billing workflow | Resolved |
| CO-22 | Service provided outside plan network; coverage not applicable | BCBS, Aetna | Network participation verification integrated into eligibility check; patient responsibility reclassified where applicable | Resolved |
BCBS accounted for $400,000+ in total denial volume across these codes. Dedicated appeal and corrective billing tracks were established per payer.
Ready to See Similar Results for Your Practice?
MBC's Revenue Cycle Management team has delivered measurable denial reduction, near-zero charge lag, and healthier AR profiles across multi-specialty practices. Schedule a no-obligation RCM Audit to identify where your practice is leaving revenue uncaptured.