Denials Turned Into Dollars for a Midwest Specialty Clinic
Case Study: Project Overview
A mid-sized specialty clinic in the Midwest, seeing over 120 patients per week, was losing substantial revenue due to persistent claim denials. With limited internal resources and outdated billing workflows, they were unable to manage appeals effectively. MCB was brought in to identify root causes and build a denial recovery system from the ground up.
Challenge:
The clinic’s billing team faced a 27% denial rate across multiple payers, including Medicare and private insurers. Denials were often due to documentation issues, missed deadlines, and inconsistent use of modifiers. Staff spent hours manually following up, with little success in overturning claims.
- High claim denial rate (27%)
- Staff overwhelmed by appeal processes
- Delayed reimbursements impacting revenue
Solution:
The clinic’s billing team faced a 27% denial rate across multiple payers, including Medicare and private insurers. Denials were often due to documentation issues, missed deadlines, and inconsistent use of modifiers. Staff spent hours manually following up, with little success in overturning claims.
- High claim denial rate (27%)
- Staff overwhelmed by appeal processes
- Delayed reimbursements impacting revenue
Results:
By month three, the clinic’s denial rate had fallen to 9%. Over $87,000 in previously rejected claims were successfully recovered. Staff workload dropped by 40%, allowing front desk and billing teams to shift focus back to patient and practice operations. Revenue became more predictable, enabling better planning.
- Denial rate reduced from 27% to 9%
- Over $87,000 recovered from previously denied claims
- 60% faster resolution time for claim appeals
Impact in Numbers:
Revenue Recovered in 90 Days (USD)
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Percentage Point Drop in Denial Rate
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Percent Faster Appeals Processing Time
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Percentage Point increase in revenue
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“We used to accept denials as a normal part of billing. MCB showed us that with the right tools and consistency, we could recover lost revenue and work smarter. Their team was responsive, professional, and incredibly proactive.”
