Highlights
Challenge: Managing high denial rates, inefficient payment posting, and a growing AR backlog while preparing for significant provider expansion and leadership transition
Solution: Automate claims management, codify billing expertise into a rules engine, and shift the RCM team to exception-based workflows
Outcome: Optimized revenue cycle operations, reducing manual workload and strengthening financial performance across the organization
A 52-provider ophthalmology and ENT group was approaching a period of growth with an RCM operation that wasn’t built to scale. High denial rates, manual payment posting, and an aging AR backlog were quietly eroding profitability while impending leadership changes put institutional billing knowledge at risk. By implementing Encoda’s automated revenue cycle management platform and rules engine, the practice reversed its financial trajectory, grew revenue by 23%, and maintained stable performance through three RCM leadership changes in three years.
Challenge: high denial rates, manual payment posting, and aging AR
The practice’s financial operations were under pressure before growth ever began. As leadership prepared to onboard new providers, it became clear that the existing revenue cycle could not scale alongside them.
The billing team was operating reactively. Manual payment posting consumed significant staff time, denial rates were high, and the team spent most of its energy chasing missing or incorrect payments rather than preventing them. At the time, 17% of the practice’s AR sat beyond 120 days, and average days in AR stood at 27. Clean claim rates were inconsistent, and the cumulative effect was a steady drain on cash flow.
The risk extended beyond operations. The practice was facing imminent staff attrition and multiple RCM leadership changes. Without a system capable of preserving institutional billing logic, every transition represented a threat to consistency and performance. The organization needed more than process improvement; it needed a platform that could absorb and retain critical expertise.
Solution: automated revenue cycle management and exception-based workflows
The practice implemented Encoda’s financial health management platform, replacing manual workflows with intelligent automation and shifting the entire RCM operation to a proactive, exception-based model.
Intelligent claims management and rules engine
The practice moved away from conventional claim scrubbing and adopted Encoda’s outcomes-based rules engine. The engine codified the practice’s billing expertise into automated logic, applying payer-specific validations before submission. Rather than responding to denials, the platform prevented them, stopping errors at the source and improving first-pass claim payment rates.
Exception-based work queues
Encoda eliminated the traditional approach of manually reviewing every claim. Instead, the platform automatically triaged incoming work and routed only the claims requiring human intervention into targeted work queues. This allowed the remaining RCM staff to concentrate on high-value exceptions, improving throughput without adding headcount.
Automated payment validation
Encoda streamlined cash posting and payment validation, removing the manual data entry that had previously consumed the billing team’s time. Remittances were processed faster and with greater accuracy, accelerating the path from charge to cash.
Outcome: revenue growth, AR improvement, and operational resilience
The practice achieved measurable improvement across revenue, operations, and long-term financial stability.
Revenue growth
Overall revenue grew 23%, driven by higher clean claim rates, fewer denials, and more efficient collections across the board.
AR improvement
Average days in AR decreased from 27 to 24.5. The percentage of AR aged 120-plus days dropped from 17% to 7%, and the practice captured 80% of all current AR within the 0–30 day window, creating a significant shift in cash flow velocity.
Staff productivity
The group eliminated six FTE positions while increasing overall staff productivity by 39%. Automation absorbed the manual workload, enabling the remaining team to operate more effectively with fewer resources.
Operational resilience
Despite navigating three RCM leadership changes in three years, the practice maintained consistent, repeatable financial performance. The Encoda rules engine preserved the organization’s claims logic through each transition, insulating financial results from the disruption that typically accompanies leadership turnover. The platform continues to protect that institutional knowledge today.
If your practice is managing growth, facing staffing challenges, or losing ground to denial rates you can’t fully see, Encoda’s financial health management platform is built to help. Let’s talk about how automated revenue cycle management can be a game-changer for your financial health.
