Case Studies

Healthcare Provider Streamlines Billing and Sees 30% Drop in Denial Rates with OutsourceRCM


  • A North Carolina healthcare provider aimed to streamline their medical billing procedures with a comprehensive solution.
  • The implemented solution addressed several challenges, leading to streamlined processes, better receivables management, and a 30% drop in initial denial rates.
  • OutsourceRCM, the provider of the solution, highlights its global expertise and a range of services that can enhance scalability.

The Story of our Customer

  • Our North Carolina-based client specializes in orthopedic treatments and aimed to optimize their billing practices with a comprehensive solution.
  • The proposed medical billing solution would adhere to rigorous standards set by entities like NUCC, CMS, and HIPAA, while meeting specific requirements of various insurance companies.
  • The client partnered with a medical billing expert to streamline claim generation, boost insurance plan strategies, ensure compliance, and refine charge entry procedures.

The challenge

The client was presented with a series of challenges that necessitated our assistance in devising comprehensive solutions. These challenges encompassed aspects such as ensuring precise and punctual charge entry, fostering private and government health insurance plan participation, and adhering to pertinent industry standards.

  • Implementing accurate and timely procedures for charge entry, ensuring precision in financial transactions.
  • Formulating strategic approaches to elevate participation in private and government health insurance plans, employing techniques like co-payment and guarantee mechanisms.
  • Offering guidance to ensure strict alignment with critical standards, including standard procedure CPT and HIPAA regulations, fostering compliance and data security.

The Solution

In response to the client's needs, a comprehensive billing solution was developed to precisely meet their requirements. This solution encompassed a range of strategic measures to enhance patient service coordination, claims generation, quality assurance, and efficient financial management.

  • Streamlined Processes: Collaborated with medical professionals for service info accuracy, maintained detailed billing records, produced uniform claims following NUCC standards, and enabled efficient electronic claims and records management.
  • Rigorous Quality Control: Formed a dedicated team for reviewing bills, ensuring accuracy in billing minor services with CPT codes, and handling versatile transactions including insurance payments, adjustments, and denials.
  • Enhanced Revenue Management: Adopted meticulous charge capture processes to optimize financial management and patient service coordination.

The Result

The solution yielded substantial outcomes for the client, enhancing billing efficiency and ensuring accurate and timely payments to healthcare providers. Additionally, it provided comprehensive insights into receivables, enabling proactive follow-ups and substantially reducing initial denial rates.

  • Optimized Billing Process: Streamlined the entire billing process, resulting in accurate and punctual payments to medical professionals.
  • Enhanced Receivables Management: Provided comprehensive insights into receivables, enabling proactive and effective follow-up actions.
  • Significant Denial Reduction: Achieved a remarkable 30% reduction in initial denial rates within the first three months of implementation.

Elevate Customer Service with OutsourceRCM

As a top-tier BPO company, OutsourceRCM offers global expertise from 5 delivery centers. Our inclusive services range from inbound support to outbound call solutions, delivering comprehensive resources for enhanced scalability.

For a reliable, profitable healthcare BPO partner, contact us today.