Billings Clinic Emergency Department Reduced Claim Denials by 64%—Here’s How
Billings Clinic Emergency Department face tough billing challenges every day. Problems such as missing documentation, different payer rules, and slow follow-ups often delay payments. These issues cause claims to be denied and receivables to age. In this case study, you’ll learn how Medical Billing Wholesalers helped Billings Clinic Emergency Department fix these issues and improve their revenue cycle in just 90 days.
For more insights, explore our Emergency Billing & Coding Services designed to improve revenue outcomes for fast-paced care settings.
Client Overview
Location: Southeastern United States
Specialty: Emergency Department
Monthly Patient Cases: Over 1,200
Monthly Revenue: $600,000
Old A/R Over 90 Days: 40% of total receivables
Challenges
The clinic struggled with several ongoing billing problems:
Claim Denials Were Too High
Many claims were denied because medical necessity was not documented well. Without proper notes, insurers often refused to pay for high-level visits.Payer Rules Were Not Tracked
Each insurance company had its own rules. But there was no system in place to track them. As a result, claims were rejected for reasons like exceeding session limits or missing required files.Physicians Lacked Clear Guidelines
Doctors weren’t given clear templates for documenting the right codes. This made it hard to support Level 4 or Level 5 billing.Old Claims Were Not Followed Up
High-dollar claims sat unpaid for months. No team was assigned to handle appeals or escalate older claims.
Our Approach
To solve these problems in the Billings Clinic Emergency Department, we created a simple but powerful plan. Our team focused on improving documentation, tracking payer rules, and following up on old claims. We worked closely with the clinic’s staff to build a better billing process that worked for them.
Analysis: Problems and Solutions
ProblemSolution ProvidedClaim denials due to documentationShared custom templates so doctors could document medical necessity clearly.Missing payer-specific trackingBuilt a central database to track payer rules like session limits and file needs.Incomplete provider notesDelivered easy-to-use templates to improve E/M documentation levels.Aged claims not addressedCreated a follow-up team to handle high-value and old claims with direct appeals.
| Problem | Solution Provided |
|---|---|
| Claim denials due to documentation | Shared custom templates so doctors could document medical necessity clearly. |
| Missing payer-specific tracking | Built a central database to track payer rules like session limits and file needs. |
| Incomplete provider notes | Delivered easy-to-use templates to improve E/M documentation levels. |
| Aged claims not addressed | Created a follow-up team to handle high-value and old claims with direct appeals. |
Results After 90 Days
With these changes, the clinic quickly saw big improvements:
Claim Denials dropped from 22% to 8%
Average A/R Days went from 76 to 38 days
First-Pass Acceptance Rate rose from 58% to 91%
Aged Receivables (Over 90 Days) reduced from 40% to 18%
Coding Errors dropped by 61%
These results improved the clinic’s cash flow and reduced stress on the billing team. More claims were paid on the first try, and fewer delays slowed the revenue cycle.
Conclusion
Billings Clinic Emergency Department was stuck with denials, slow payments, and aging claims. But with help from Medical Billing Wholesalers, they turned things around. Better templates helped doctors document correctly. A new system kept payer rules easy to follow. And a follow-up team made sure old claims didn’t fall through the cracks.
This case proves that smart billing fixes can lead to real results. With teamwork, simple tools, and better tracking, even the busiest emergency departments can succeed.
Explore another success story: How We Fixed Patient Registration Delays in the ED
“We were buried in denials, and our A/R was climbing fast. Partnering with Medical Billing Wholesalers gave us the structure we needed to take control.”
– Revenue Cycle Director, Billings Clinic Emergency Department
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