Lifted net collection 19% in nine months.
A 14-provider cardiology group switched from a national RCM vendor that treated them like a ticket number. Nine months later, net collection was up nineteen points and days in AR had nearly halved.
+ 19%
Net collection
+ 19%
Net collection lift
24
Days in AR (from 44)
98.6%
Clean-claim rate
71%
Denial appeal win rate
The challenge
Cedar Creek was bleeding revenue on prior-auth denials for cath and advanced imaging, and their previous vendor's offshore team couldn't get a cardiologist on the phone. Modifier 26/TC splits were inconsistent, and nobody was appealing CO-50 medical-necessity denials — they were just writing them off.
What we did
- Rebuilt the prior-auth workflow so cath and imaging auths are pulled and tracked before the procedure.
- Standardized 26/TC professional-technical splits across all diagnostic cardiology.
- Started appealing every medical-necessity denial with the clinical detail that wins them.
- Put a dedicated CSM on monthly calls with the practice manager and lead cardiologist.
"We switched from a name-brand RCM that treated us like a ticket number. ClearClaim picks up the phone, knows our payer mix, and our net collections are up nineteen points."
AP
Dr. Anand Patel
Managing Partner, Cedar Creek Cardiology
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