The organization
A fictional outpatient behavioral health group with 18 providers across three locations. The example models recurring visits and a mixed commercial and public-payer population.
Where the work was getting stuck
The starting inventory combined authorization denials, unanswered claims, and balances awaiting documentation. Staff revisited accounts without a consistent next action, and authorization status was not reliably visible to scheduling.
A defined engagement scope
An agreed legacy A/R inventory, denial follow-up, and an authorization exception handoff. Current-day clinical documentation and routine payment posting stayed with the practice.
The actions taken
- Validate the opening inventory and separate denials, no-response claims, and unresolved patient responsibility.
- Prioritize follow-up by filing deadline, documentation readiness, and outstanding value.
- Assign an owner and dated next action to every in-scope account; review blocked work with the practice weekly.
- Return recurring authorization issues to a shared pre-visit exception list.
ILLUSTRATIVE DATA ONLY
Results, with a definition attached.
Comparison of the opening baseline and final month of this six-month illustrative engagement. Values are invented for this concept.
| Measure | Baseline | Final month |
|---|---|---|
| A/R over 90 days / total A/R | 32% | 21% |
| In-scope accounts with a documented next action | 46% | 94% |
| Unresolved authorization exceptions at monthly close | 86 | 39 |
What these numbers do not establish
All organizations and numbers are invented to demonstrate reporting. The A/R share is balance-weighted at each month-end, not a recovery rate. Receipts, adjustments, new charges, and changing payer mix can all affect it. No actual client outcome or guaranteed improvement is represented.
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