RCM Case Study: Improving Cash Flow and Reducing Billing Stress Through Eligibility and A/R Optimization

A growing imaging center in the USA faced a lot of revenue and billing problems and partnered with Dilijent Systems. 

The center handled MRI, CT, X-ray, and ultrasound services, with a high volume of patients and many different types of payers. Despite a huge number of patients and daily dealings, the organization suffered from cash flow problems, frequent claim rejections, and stress among the administration staff. 

The Challenge

Before partnering with us, the imaging center faced a lot of revenue cycle problems, including these:

1. Eligibility-Related Claim Rejections

Many claims were rejected because the staff didn’t focus on insurance eligibility verifications and prior authorizations. 

2. Growing A/R Backlog

Over 40% of claims were still unpaid after 45 days, creating serious cashflow problems.

3. Patient Billing Confusion

Patients often received unexpected bills that created frustration among the customers. This led to delayed payments and write-offs.

4. Limited Visibility Into Payer Performance

The billing team lacked clear reporting on which payers caused delays, underpayments, or repeated denials.

5. Staff Burnout in Billing Team

Billing staff spent most of their time reworking claims instead of moving new claims forward. This caused a lot of burnout and technological complexity among the employees.

How Dilijent Systems Solved the Problem

Dilijent Systems designed a focused revenue cycle management solution strategy centered on eligibility accuracy, A/R cleanup, and payer accountability. Here are some of the main strategies that Dilijent Systems opted to improve the cash flow and revenue of the imaging center:

1. Front-End Eligibility and Authorization Audit

We closely reviewed the appointment scheduling systems and how insurance was checked before treatment. Our team is highly focused on prior insurance authorization to ensure that every treatment is covered by the patient’s insurance company. We also linked common claim denials directly back to front-desk errors so they could be fixed at the source.

2. Real-Time Eligibility Verification Process

We executed same-day insurance checks for all the patient visits. Coverage, benefits, and patient responsibilities were confirmed prior to the visit. Any authorization requests were communicated early, even before the service was given, to eliminate the chances of future denials.

3. A/R Recovery and Cleanup Plan

Our primary attention was directed towards high-value, old unpaid claims first. Claims aged over 30 days were subject to very strong and consistent follow-up. Each payer was treated differently according to how they process and delay payments.

4. Payer Underpayment Review

Payments were reviewed against payer contracts to identify short ones. Claims that had been underpaid were quickly identified and appealed in order to recover the revenues that had been missed.

5. Patient Billing Support

Before the patients’ visits, clear cost estimates were given to them. Billing statements were made clearer and simpler to understand. This led to a decrease in confusion and, therefore less number of billing-related phone calls.

6. Clear Monthly Reporting

We sent monthly reports that were very simple and easy to read, and that showed: 

• Payer-wise Aging A/R 

• Eligibility-related Denials 

• Payment patterns of Underpayment 

• Overall cash flow monthly

Results Achieved (Within 90 Days)

1. Eligibility-Related Denials Reduced by 65%
As the prior authorization strategies were implemented, the claim denial and rejection rate went down.

2. A/R Over 45 Days Reduced by 52%
We resolved unpaid claims faster, in under 45 days, that lead to a surprising enhancement in cash flow.

3. Monthly Collections Increased by 31%
Faster payments and recovered underpayments boosted revenue.

4. Patient Complaints Dropped by 40%
Our patients became satisfied with our services and billing practices once they stopped getting surprise bills.

5. Billing Team Productivity Improved by 22%
Our administration staff escaped the permanent cycle of stress and complexity, which enhanced their productivity by 22%.

Client Testimonial

“Dilijent Systems changed the trajectory of our cash flow and revenue streams. Our cash flow is now stable, denials are way less than before, and our administrative staff is no longer under constant stress. Thanks to the highly effective strategy of Dilijent Systems, we started seeing real improvements in the first two months.”
Operations Manager, Outpatient Imaging Center