- Case Study
Boosted Cash Flow by 35% by Streamlining RCM
Industry:
Healthcare
Location:
USA (5 states)
Tools & Technologies:
Tools & Technologies Availity, ClinIntell, Tableau, TruCode, PracticeSuite, AI-based Claim Scrubbing, Robotic Process Automation
Challenges
The client’s existing revenue cycle operations were highly fragmented. Manual data entry, inaccurate coding, and poor charge capture led to a denial rate of over 22%. Their eligibility verification process was reactive, often performed after services were rendered, resulting in rejections from insurers and delayed patient billing.
Moreover, the reporting and oversight capabilities of the system were virtually non-existent. Finance and operations leadership lacked access to real-time KPIs such as claim acceptance rates, AR aging, and collection efficiency. With AR days exceeding 52 and growing, the organization faced growing liquidity constraints.
Solution
TronsIT Solutions initiated a comprehensive RCM audit, identifying systemic bottlenecks in claims management and payment collection. They deployed an AI-based claim scrubbing engine that proactively flagged coding and billing errors before submission. The platform automated insurance eligibility checks at the time of appointment scheduling, reducing downstream denials. TronsIT Solutions integrated their technology seamlessly with the client’s existing EHR.
Robotic process automation was introduced to streamline repetitive back-end operations such as payment posting, secondary claims filing, and denial follow-up. A centralized analytics dashboard offered real-time insights into revenue cycle metrics. TronsIT Solutions provided comprehensive training for the internal billing team and established new workflows aligned with payer requirements.
Outcomes
The implementation of the Sophos-based managed network infrastructure delivered significant benefits:
01
35% Increase in Cash Flow
Enhanced collections and reduced AR days led to stronger and more consistent liquidity across the organization.
02
50% Reduction in Claim Denials
AI-driven pre-submission checks and coding accuracy significantly decreased rejections and revenue loss.
03
Improved KPI Visibility
Real-time, centralized dashboards enabled leadership to track and act on performance metrics instantly.
04
17 Days Reduction in AR Days
05
60% Automation in RCM Workflows
Robotic process automation handled repetitive tasks, lowering manual effort and operational costs.