Revenue cycle management audits have become critical tools for healthcare organizations struggling with mounting accounts receivable and declining cash flow. Healthcare providers face increasing pressure from complex billing regulations, evolving reimbursement models, and the growing emphasis on patient financial experience. When a multi-specialty clinic in the Midwest found itself drowning in accounts receivable over 90 days, it turned to a comprehensive RCM audit improved AR 90 days case study approach to identify the root causes of its financial challenges.

The results were remarkable: a 40% improvement in AR over 90 days, along with significant gains across multiple financial metrics. This RCM audit improved AR 90 days case study demonstrates how data-driven approaches to revenue cycle management can transform a healthcare practice’s financial performance and long-term sustainability.

Client Background and Challenges in the RCM Audit Improved AR 90 Days Case Study

The client, a multi-specialty clinic located in the Midwest, serves a diverse patient population across multiple service lines. Like many healthcare providers, they had been experiencing increasing challenges with their revenue cycle management processes. The clinic’s leadership team was committed to improving financial performance and patient satisfaction, recognizing that these two goals are increasingly interconnected.

The primary challenge facing the clinic was its growing accounts receivable over 90 days, which had reached unsustainable levels. This extended AR cycle was creating significant cash flow problems, limiting the clinic’s ability to invest in new technologies, hire additional staff, or expand services. The situation was compounded by rising denial rates, inefficient billing processes, and a lack of real-time visibility into revenue cycle performance.

Healthcare industry trends were making these challenges even more acute. The increasing complexity of billing and coding regulations was leading to higher denial rates across the industry. The growing adoption of value-based care models required more accurate and efficient RCM processes. The rise of telehealth services had introduced new coding and billing challenges that many practices were still learning to navigate.

The RCM Audit Improved AR 90 Days Case Study Process

The comprehensive RCM audit improved AR 90 days case study began with a detailed analysis of the clinic’s current processes, from patient registration through final payment collection. The audit team examined every touchpoint in the revenue cycle, looking for inefficiencies, errors, and missed opportunities for improvement.

The audit process included several key components:

• Data Analysis and Performance Benchmarking: The team analyzed historical billing data, denial patterns, and payment timelines to establish baseline metrics and identify trends. This data-driven approach revealed specific areas where performance was lagging behind industry standards.
• Process Mapping and Workflow Assessment: Every step of the revenue cycle was documented and analyzed, from patient scheduling and registration through claim submission and payment posting. This comprehensive review identified bottlenecks and inefficiencies that were impacting operational efficiency.
• Technology and System Evaluation: The audit examined the clinic’s existing RCM technology stack, including their practice management system, billing software, and reporting tools. The team assessed how well these systems supported efficient workflow and whether they provided adequate real-time visibility into performance metrics.
• Staff Training and Competency Assessment: The audit included interviews with billing and coding staff to assess their understanding of current regulations, best practices, and system capabilities. This revealed gaps in knowledge and training that were contributing to errors and inefficiencies.

Key Findings from the RCM Audit Improved AR 90 Days Case Study

The comprehensive RCM audit improved AR 90 days case study revealed several critical issues that were driving the clinic’s poor AR performance:

• Coding and Documentation Issues: The audit identified significant problems with coding accuracy and clinical documentation. Many claims were being denied due to insufficient documentation or incorrect code selection. The coding staff needed additional training on recent updates to CPT and ICD-10 codes, as well as a better understanding of documentation requirements for different service types.
• Patient Registration and Eligibility Verification Problems: The front desk staff were not consistently verifying insurance eligibility prior to appointments, leading to numerous claim denials. Additionally, patient demographic information was frequently incomplete or inaccurate, causing delays in claim processing.
• Claim Submission and Follow-up Deficiencies: The clinic was experiencing significant delays in claim submission, with many claims not being submitted within optimal timeframes. More concerning was the lack of systematic follow-up on denied or unpaid claims, resulting in many receivables aging beyond 90 days without any collection efforts.
• Inadequate Reporting and Performance Monitoring: The clinic lacked comprehensive reporting tools that would allow it to monitor key performance indicators in real time. Without this visibility, problems were going unnoticed until they had already significantly impacted cash flow.

Strategic Solutions from the RCM Audit Improved AR 90 Days Case Study

Based on the audit findings, the RCM team implemented a comprehensive improvement plan targeting each identified area of weakness. Following best practices recommended by AdvancedMD and Enter.Health, the clinic focused on enhancing automation, staff training, and data visibility.

• Enhanced Coding and Documentation Processes: Intensive training was provided for coding staff on current regulations and best practices. New documentation review processes were implemented to ensure clinical notes supported the codes being submitted. These changes directly addressed many of the root causes of claim denials.
• Streamlined Patient Registration and Eligibility Verification: New workflows were established, requiring insurance eligibility verification for all appointments. Staff received training on proper data collection techniques, and new quality control processes were implemented to ensure the accuracy of patient information.
• Automated Claim Management and Follow-up: The clinic implemented new automated systems for claim submission and denial management. These RCM solutions provided real-time tracking of claim status and automated follow-up processes for denied or unpaid claims. This systematic approach ensured that no receivables would fall through the cracks.
• Comprehensive Performance Monitoring and Reporting: New reporting dashboards were implemented, providing real-time visibility into key metrics including clean claim rates, denial rates, and AR aging. This allowed the clinic’s leadership to identify and address problems quickly, before they could significantly impact cash flow.

Results of the RCM Audit Improved AR 90 Days Case Study

The implementation of these strategic improvements delivered impressive results across multiple performance metrics:

• 40% Improvement in AR Over 90 Days: Accounts receivable over 90 days decreased by 40%, directly improving the clinic’s cash flow and financial stability.
• 25% Reduction in Denial Rates: Improved coding and eligibility verification reduced claim denials, cutting administrative burden and accelerating reimbursements.
• Clean Claim Rate Improvement from 60% to 90%: The percentage of claims processed without correction jumped from 60% to 90%, streamlining operations.
• Decreased Average Days to Payment: Average days to payment dropped from 75 to 50, improving revenue turnaround.
• 15% Increase in Overall Revenue: Better billing and collection processes led to a 15% increase in overall revenue.
• 20 Hours Weekly Time Savings: Automation saved the billing team roughly 20 hours per week, allowing focus on strategic revenue tasks.

“The RCM audit provided us with actionable insights and strategies to transform our billing processes,” said the clinic’s leadership. “Thanks to the audit, we’ve significantly reduced our AR days and strengthened our financial health.”

The Long-Term Impact of the RCM Audit Improved AR 90 Days Case Study

This RCM audit improved AR 90 days case study highlights the transformative power of thorough revenue cycle management audits. By addressing coding errors, automation gaps, and workflow inefficiencies, healthcare organizations can dramatically improve financial outcomes.

The success extended beyond numbers — improved staff satisfaction, enhanced patient billing experiences, and better operational transparency. With a more efficient RCM system, leadership gained real-time visibility for decision-making and long-term planning.

Ultimately, the improved cash flow positioned the clinic for sustainable growth. With a stronger financial foundation, they could invest in advanced technologies, expand service lines, and attract top talent — reinforcing the clinic’s mission to deliver exceptional patient care while maintaining financial excellence.