Ophthalmology group practice achieves 48% productivity boost through RCM transformation

A Florida-based ophthalmology group with eight providers was managing its revenue cycle through manual claims workflows and limited financial visibility inside its Nextech platform. By implementing Encoda’s rules engine, exception-based work queues, and real-time analytics, the practice automated routine billing work and gained the oversight it had been missing. Days in AR fell by more than half within five months and team productivity climbed 48%.

Challenge: manual claims workflows and limited visibility in Nextech

The eight-provider ophthalmology group ran a busy, growing practice, but its billing operation hadn’t kept pace. Leadership recognized that manual, labor-intensive processes were adding administrative cost and reducing the group’s ability to move quickly.

Inside their Nextech practice management platform, claims processing consumed much of the staff’s day. With no proactive scrub rules in place to catch errors early, team members spent hours tracking down rejections and denials after the fact. That reactive cycle pulled their attention away from high-value exceptions and strategic work.

Visibility was the other half of the problem. Leadership lacked timely, actionable insight into revenue cycle performance, which made it hard to spot delays or identify recurring denial trends. Without a way to validate claims before submission, those hidden inefficiencies steadily reduced profitability and stretched out days in AR.

Solution: RCM automation, claims scrubbing, and real-time analytics

The group implemented Encoda, concentrating on three areas that strengthened its Nextech environment and reshaped the revenue cycle.

Smarter claims processing

Encoda deployed a rules engine that moved the group from reactive billing to proactive claim scrubbing. The team built tailored, multi-tiered rules matched to each payer’s criteria, so the system flags and resolves coding issues before claims reach the clearinghouse.

Exception-based work queues

Encoda restructured the team’s daily work around exceptions. The platform automatically prioritizes and routes only the claims that genuinely need manual attention to specialized queues. That removed the need to review every claim individually and freed staff to focus on high-impact accounts.

Actionable RCM analytics

Encoda brought the group’s previously disconnected revenue cycle data into a unified real-time view. Leadership can now track first-pass payment rates, monitor payer trends, and spot revenue opportunities early, making informed decisions before issues reach the bottom line.

Outcome: cleaner claims, faster cash flow, and higher productivity

The shift to automated workflows and data-driven oversight produced measurable gains across claim accuracy, cash flow, and productivity.

Higher claim accuracy

The new rules engine cut claim denials significantly and lifted the practice to a 95% first-pass claim pay rate.

Faster cash flow

Within five months, days in AR dropped from more than 47 to an average of 22.9. The group also added a 0.31% increase in net insurance collections over the prior six-month period, all while onboarding an additional provider.

Greater productivity

Automation absorbed much of the routine workload, allowing the group to grow total charges by 23% while reducing RCM staffing by one full-time position. Together, those changes produced a 48% jump in administrative productivity.

The group now operates a predictive, streamlined revenue cycle and can onboard new providers and absorb higher patient volumes without adding strain to its administrative team.

If your practice is managing manual billing workflows or limited visibility into revenue cycle performance, we’re happy to walk through your current revenue cycle operations and discuss how automation could help.