Ophthalmology group unlocks $7.95M in cumulative ROI with Encoda

A 12-provider ophthalmology group was losing ground to a difficult payer mix, mounting denials, and $4.94 million trapped in aging accounts receivable. By deploying Encoda’s revenue cycle automation, custom claims rules, and exception-based workflows, the practice reversed its financial trajectory—reducing days in AR by 35 days, increasing net insurance collections by 10.8%, and generating a cumulative ROI of $7.95 million.

Challenge: claim denials, aging AR, and limited revenue cycle visibility

For a 12-provider independent ophthalmology group, financial performance was under serious pressure. The practice carried a complex payer mix that produced unpredictable rules, frequent claim denials, and inconsistent reimbursements. Without real-time visibility into their revenue cycle, the billing team operated reactively—manually sorting through large claim volumes to find problems, chasing down missing payments, and relying on disconnected reports to assess financial health.

The burden fell on a six-person RCM team that spent most of its time reviewing healthy claims rather than resolving high-priority exceptions. The result: days in AR climbed to 85 days, and over $4.94 million sat stagnant in the 120-plus day AR bucket. Cash flow was constrained, the cost to collect was high, and the practice had little visibility into where revenue was being lost or why.

Solution: RCM automation, claims rules, and revenue cycle analytics

The practice implemented Encoda’s financial health management platform, deploying three core capabilities to shift from a reactive to a proactive model.

Custom claims rules and proactive scrubbing

Rather than relying on standard clearinghouse edits alone, the practice used Encoda’s rules engine to build payer-specific claim validations before submission. By identifying and correcting issues upstream, the results engine stops denials before claims ever leave the practice.

Exception-based work queues

Encoda’s workflow automation filters out routine transactions, automatically validating expected remittances and surfacing only true exceptions for staff review. This allows the billing team to concentrate entirely on claims that require human intervention and maximizing the impact of every hour worked.

Revenue cycle analytics

The practice moved away from static spreadsheets and gained real-time visibility into performance by payer. Encoda’s analytics tools now give leadership the ability to identify delays early, track trends in their payer mix, and pinpoint the root causes of revenue leakage before they compound.

Outcome: faster cash flow, higher collections, and $7.95M ROI

The results were immediate and measurable across multiple areas of the practice’s revenue cycle and they continue to operate at that higher level of performance today.

Operational efficiency

The practice achieved a 98% first-pass payment rate on clean claims, reducing rework to near zero. With automation handling routine validations, the billing team was restructured from six full-time employees to three—a 50% reduction in headcount. The team now operates at a higher level of productivity with fewer staff.

Accelerated cash flow

Within the first 12 months, days in AR dropped from 85 to 50. The 120-plus day AR bucket was cut nearly in half, falling from $4.94 million to $2.5 million.

Financial performance

Net insurance collections increased by 10.8%, generating more than $3.2 million in annualized collection growth. When combined with days-in-AR savings and FTE cost reductions, the practice realized a total cumulative ROI of $7.95 million.

Ready to see what Encoda can do for your practice? Let’s talk more about your current revenue cycle challenges and how our platform can improve your financial health and reduce your cost to collect.