An extended RCM team for complex surgical claims.
Revantage expanded from additional operational capacity to shared ownership across authorization, pre-bill review, payment integrity, aged A/R and case-level reporting.
The challenges behind the engagement.
- The practice initially needed additional operational capacity.
- Complex, high-value cases required follow-through from authorization to final payment.
- Authorization, coding readiness, underpayments and aged A/R needed coordinated ownership and visibility.
Practical changes across the workflow.
Own authorization follow-through
Managed complex-procedure authorization, rapid action on urgent requests and peer-to-peer coordination when clinical review was needed.
Review before billing
Reviewed diagnosis coding, modifiers, payer requirements and overall claim accuracy.
Protect payment integrity
Compared payments with contracts and pursued appropriate underpayment challenges.
Work aged receivables
Confirmed documentation and pursued corrected claims, reconsiderations and appeals.
Track cases end to end
Maintained a consolidated surgery tracker and coordinated IDR/NSA support with external vendors, including deadlines, next actions and resolution follow-through.
Keep leadership informed
Provided weekly operating calls, monthly business reviews and recurring analytics on payer behavior, aging, time to pay and surgery status.
What changed for the practice.
- Monthly collections increased from approximately $400K to $750K.
- The engagement reported a 98% authorization approval rate.
- Urgent authorization requests were acted on within two hours; approvals typically took 48–72 hours when payer timelines allowed.
- Underpayment review, aged-A/R escalation and IDR/NSA tracking supported continued payment follow-through.
An extended RCM team connects daily execution with the follow-through and visibility that complex surgical reimbursement requires.
Authorization action time is distinct from approval time. Approval decisions and turnaround depend on the payer. IDR/NSA support includes case tracking and external-vendor coordination.
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