V O B

Case Study

How Summit Family Medicine reduced claim denials by 60% and improved collections by 35%

4-location primary care group • 12 providers • 300+ patient visits daily • Commercial, Medicare, Medicaid mix

60%

Claim denial reduction

35%

Collections improvement

$180K

Bad debt reduced/year

The Challenge

8-12% claim denial rate from eligibility issues.

• Patients arriving with termed coverage → bad debt
• Front desk spending 20+ hours/week on phone verifications
• High-deductible plan patients shocked at bills
• Missing referrals causing denials weeks post-service
• No systematic way to catch eligibility issues upfront

Medical Solutions

The Solution implemented

Real-time eligibility verification at appointment scheduling, rules flagging inactive coverage and high deductibles, auto-alerts for missing PCP referrals for specialists, and integration with Athenahealth EHR.

The Impact

Revenue cycle transformed in 60 days.

• Claim denial rate: 12% → 4.8% (60% reduction)
• Patient collections: Up 35%
• Verification time: 20 hrs/week → 3 hrs/week
• Bad debt write-offs: Down $180K/year
• Front desk staff can focus on patient experience

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Every Response

Key fields included

Your policies, encoded once. Enforced forever.

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Set up automatic deny or needs-more-info gates based on your facility's acceptance criteria and service lines.

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Create facility-specific and program-specific rules that reflect the unique requirements of each service line.

Score-Based Decisioning

Optional predictive scoring combines multiple factors to help prioritize patients and flag edge cases.

Versioning & Audit Trail

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Trusted by healthcare organizations.

We reduced manual VOB time from 4 hours to 15 minutes per patient. The decisioning engine gives us consistent results across all 12 facilities, and our admissions team can finally focus on patient care instead of chasing payers.

Sarah Mitchell

Director of Admissions, Behavioral Health Network

The rules engine is a game changer. We encoded our policies once, and now every patient gets evaluated the same way. Fewer delays, cleaner data in Salesforce, and we have an audit trail for compliance.

Michael Chen

VP Operations, Regional Treatment Centers

The API integration was straightforward, and the normalized output means we don't have to parse different payer formats anymore. We've seen a 70% reduction in admissions delays caused by missing benefit information.