The organization
A fictional multispecialty group with 24 clinicians at three locations, using one practice management system with locally managed documentation and billing queues.
Where the work was getting stuck
Unbilled encounters were tracked differently at each site. The billing team could not readily distinguish unsigned notes from coding questions or enrollment holds. Submitted batches were not consistently matched to acknowledgments.
A defined engagement scope
Workflow mapping, claim preparation, acknowledgment monitoring, and a common readiness report. Provider enrollment decisions, clinical documentation, and payer contracting remained with the group.
The actions taken
- Create a common status dictionary for unsigned, coding hold, ready, submitted, and accepted.
- Reconcile encounters to prepared claims and map each dependency to a local owner.
- Pilot the shared queue at one location, with a daily exception review before expanding.
- Pair submission-lag reporting with acceptance checks so faster work does not hide more rejections.
ILLUSTRATIVE DATA ONLY
Results, with a definition attached.
Comparison of the opening baseline and final month of this four-month illustrative engagement. Values are invented for this concept.
| Measure | Baseline | Final month |
|---|---|---|
| Median encounter-to-submission lag | 8 days | 4 days |
| First-pass accepted claims / first submissions | 89% | 95% |
| Unbilled encounters older than 14 days at close | 173 | 71 |
What these numbers do not establish
Synthetic example only. Lag is measured in calendar days for claims first submitted during each comparison month. Acceptance is an intake status, not payment. The baseline and fourth month are compared; changes in staffing, service mix, and volume may influence these measures.
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