Healthcare & RCM

Your Denial Rate Looks Manageable. Your Cost Per Resolution Doesn't.

Revenue cycle and patient access operations are measured on denial rates and days in A/R. But the true cost of resolving a patient inquiry, authorization request, or billing dispute is 2-5x higher than the per-contact metric suggests — hidden inside rework loops, callback chains, and coding escalation patterns.

3 Fault Lines That Hit Healthcare RCM Hardest

Fault Line

Authorization Callback Loops

Prior authorization requests that require 2-4 follow-up calls to payers before resolution. Each callback adds $12-18 in agent time and 1-3 days in cycle time, but is logged as a separate contact.

Typical exposure: $400K-$900K/yr
Fault Line

Denial Rework Inflation

Denied claims that cycle through rework queues 2-3 times before appeal or write-off. The rework cost often exceeds the original claim value, but is buried in aggregate denial rates.

Typical exposure: $600K-$2M/yr
Fault Line

Coding Escalation Cascade

Complex coding questions that escalate from patient access to billing to clinical coding and back. Each handoff adds cost and error risk. Resolution takes 5-10 touches across 3+ departments.

Typical exposure: $200K-$500K/yr

What Data We Need

Anonymized CSV exports from your RCM platform and telephony system. No API integrations. HIPAA-safe: we work with de-identified operational data only.

Patient contact interaction records (30 days)
Denial/rework queue logs
Authorization request/callback logs
Escalation/transfer disposition data

Find the resolution cost your denial rate is hiding.

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