JRW / Medical / Claims and payments case study
Thirty-five hours a week back on claims and payments.
Internal medicine practice · Northeast · 5 providers · 2 locations
Billers were checking claims by hand and taking the payer’s word on what it paid. JRW’s agent now reads each visit note in the practice’s EHR, scrubs the claim against the payer’s rules and the contract, works the denials, and checks every payment against what was agreed.
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35 hrs
of billing staff time saved every week.
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96%
of claims accepted first time, up from 84%.
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$68k
in underpayments found in the first year.
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31 days
in accounts receivable, down from 46.
Every claim was checked by hand, or not at all.
Coding errors cut both ways. A claim billed too high is denied or clawed back; one billed too low is money the practice earned and never asked for.
The practice sends about 450 claims a week from two offices. Two billers checked them between posting payments and chasing denials, and roughly one claim in six came back. Denials were worked when there was time, and nobody had time to check what the payers paid against the contracts.
What happens to a visit.
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001
Reads the note in the EHR
The agent reads the visit note in the practice’s own EHR for what was done and for how long, and compares it with the codes on the claim. Nothing is exported or re-keyed.
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002
Scrubs the claim
The agent checks the claim against national coding edits and the payer’s own policies, in both directions: codes billed above what the note supports, and services in the note that were never billed. Each finding shows the sentence and the rule it rests on.
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003
Prices it from the contract
The agent reads the payer’s contract into a price list, so the claim carries the right codes for that payer and the amount it should pay.
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004
Sends it through the clearinghouse
Once a biller accepts the findings, the agent sends the corrected claim through the clearinghouse the practice already uses. It reads rejections and acknowledgements as they come back, so nothing sits unsent.
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005
Works the denials
The agent logs every denial and sorts it by reason. Where the fix is clear, it corrects and resubmits the claim; where it isn’t, it drafts an appeal with the evidence attached. A biller sees every write-off before it happens. See claim denial statistics for how often payers deny claims, and why.
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006
Checks the payment
The agent compares each remittance with the contract and posts the payment to the encounter in the EHR. For an underpayment, it pulls the contract page and drafts a dispute letter.
The wins.
- 35 hours of billing staff time back every week, most of it from second checks and denial chasing the agent now does.
- First-pass acceptance up from 84% to 96%, and days in accounts receivable down from 46 to 31.
- $68k in underpayments found in the first year, each with the contract page and a drafted dispute.
- The agent finds missed revenue as well as errors: services written up in the note but never billed.
- The agent reads from and writes to the practice’s existing EHR and clearinghouse. Nobody re-keys anything.
- The agent turns each payer contract into a price list and checks every payment against it.
Built for regulated work.
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A biller approves
Nothing changes on a claim until a biller accepts the finding.
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Never guesses
Where the note is silent, the agent holds the claim and asks the clinician.
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Evidence on every finding
Each one cites the sentence in the note, the rule or the contract page.
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BAA first
We signed a BAA with the practice before the build started.
Tell us how many claims you send a week.
A 30-minute call with Jeff. You’ll leave knowing whether it’s worth automating and how we’d connect to your EHR. Each automation is quoted as one fixed price, and if the first misses the scope we agree, you don’t pay for it. Paying a billing company now? Price billing in-house against a billing company, and read how to replace your billing company.
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