How an Ohio urology practice cut AR days by 49% and costs by 77%

Overview

A prominent Ohio-based urology group, operating across multiple locations, provides advanced diagnostics and specialized treatments, including high-value urinary incontinence implants.

Despite leveraging the NextGen system, the practice relied heavily on manual, in-house workflows, creating significant operational bottlenecks.

Firstsource partnered with the practice to stabilize operations, reduce revenue leakage, and address complex reimbursement challenges affecting specialized procedures.

Challenges

The client faced a dual crisis of operational inefficiency and revenue leakage.

• Manual workflows created bottlenecks that slowed claim processing and increased error rates.
• A 9% denial rate and a clean claim rate of just 86% drove up rework, delays, and lost revenue.
• AR days had climbed to 73, significantly slowing cash flow across the practice.
• A critical Medicare reimbursement gap left the physician owner unable to secure appropriate reimbursement for complex urinary incontinence implant procedures. This threatened the financial viability of offering these essential treatments.

The practice needed a partner who could both fix operational inefficiencies and solve industry-wide reimbursement challenges that threatened the viability of offering essential treatments.

How We Made It Happen

Firstsource applied an "inch wide, mile deep" approach, combining broad operational overhaul with deep clinical-financial expertise.

• RCM process optimization: We deployed "Reimburssence," our intelligent AR platform, to conduct a root cause analysis of the backlog. We implemented new rules and edits directly within the client’s NextGen system to "pre-scrub" claims, preventing coding errors before submission. We also established a weekly governance model to prioritize denials by payer and category.
• Reimbursement gap analysis: We discovered urology practices were generally paid 35% less than allowed by commercial payers, and Medicare reimbursement was only 10% of commercial rates. Armed with this data, we identified a reimbursement solution not just for this client, but for the wider industry, bridging the gap between payer policies and provider reality.

Conclusion

What began as an operational improvement engagement evolved into a strategic partnership that solved both practice-specific and industry-wide challenges.

Consistent performance improvements and strategic value creation led the client to expand the engagement into a comprehensive end-to-end RCM partnership.