CASE STUDIES · PROOF, NOT PROMISES

The turnarounds, with the numbers shown.

69 engagements across ABA, therapy, dental, hospital, FQHC, SUD, and risk adjustment. Every one is method-first: the leak we found, the control we installed, the number that moved. De-identified, senior-partner led.

69 case studiesEvery specialty we serveMethod over anecdoteDe-identified archetypes
Authored by ASP-RCM Solutions Team · Last updated: August 16, 2026
Aggregate outcomes

90-day averages across the ASP-RCM ABA portfolio.

22% → <6%
first-pass denial rate
90-day average
50d → ~28d
AR days
Weighted average
+11hrs
returned per BCBA / week
Back to clinical work
+18%
net collections
Same volume, same payer mix

The full case library

Filter by your specialty. Each study names the control that did the work, so your team can run the same play.

ABA & Autism$3.1M
Article · ABA & Autism

Three-way match cut denials to 5.9%. $3.1M recovered.

A multi-state ABA chain stopped revenue leakage with the ASP three-way match of authorization, supervision, and documentation.

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ABA & AutismABA
Article · ABA & Autism

Engagement Pattern: How ABA chains lift commercial collections.

What a typical commercial-payer recovery engagement looks like for a multi-site ABA chain transitioning from generic billing to specialty-aware RCM.

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ABA & Autism97155
Article · ABA & Autism

The fix was not a modifier. It was two rendering providers and a note that proved it.

How a 40-BCBA autism group stopped concurrent-supervision denials on 97155 billed alongside 97153, using rendering-provider separation and…

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ABA & Autism$1.4M
Article · ABA & Autism

Three-way match reversed $1.4M of post-pay takebacks.

How a 42-site ABA chain reversed $1.4M of post-pay takebacks by gating every claim on authorization, supervision ratio, and the EHR session note.

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ABA & Autism97155
Article · ABA & Autism

One biller, one spreadsheet, zero documentation

How a Medicaid ABA practice rebuilt its revenue cycle after losing its in-house biller: the three-way match, authorization burn-down, 97155 capture,…

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Denials & AR$640K
Article · Denials & AR

ASP-RCM Case Study. $640K recovered from aged AR in the first 120 days.

How a structured aged-AR work-down on accounts >120 days recovered $4.2M for a multi-specialty group, with the workflow we used.

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AI & AutomationCapturing
Article · AI & Automation

Capturing documented secondary diagnoses without leaking PHI

How CorePulse surfaces chart-documented secondary diagnoses a manual pass missed, working behind a fail-closed de-identification boundary so no PHI…

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ASC & SurgicalASC
Article · ASC & Surgical

The device money was on the claim. It just was not on the check.

How a multispecialty ASC stopped silently under-collecting the device-cost portion of device-intensive procedures by rebuilding its billing around…

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Coding & Compliance$4.8M
Article · Coding & Compliance

ASP-RCM Case Study. $4.8M audit closed with zero clawback in 24 hours.

Defending a hospital DRG validation audit without conceding revenue: the documentation playbook, appeal sequence, and outcome.

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Coding & Compliance99.4%
Article · Coding & Compliance

ASP-RCM Case Study. 99.4% on-time re-authorizations across 142 active clients.

How an ABA network cut authorization-lapse denials by 87% with a re-auth workflow that runs 30 days ahead of expiry.

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ABA & AutismABA
Article · ABA & Autism

BCBA time to bill cut from 97 days to 22.

14-state ABA chain cut BCBA enrollment from 97 days to 22 days via parallel commercial and Medicaid submission through CredPro.

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Therapy & RehabAT
Article · Therapy & Rehab

The AT modifier holds up only when your note proves active, corrective care

How a chiropractic practice reversed AT-modifier maintenance denials by documenting active corrective care and running a clean ABN workflow for…

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Coding & Compliance93296
Article · Coding & Compliance

A clean 30-day cardiac remote monitoring cycle, with zero frequency overlap

How a 12-provider cardiology group anchored CPT 93296, 93297, and 93298 to non-overlapping 30 and 90-day billing cadences so remote cardiac…

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Behavioral Health99492
Article · Behavioral Health

Standing up Collaborative Care billing (99492-99494) in a primary-care-embedded team

How a community behavioral health clinic stands up CoCM billing with 99492, 99493, 99494 and G2214, including the behavioral care manager time log…

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CredentialingCAQH
Article · Credentialing

From application to approved, with fewer days spent waiting

How ASP-RCM's Credential OS shortens elapsed payer enrollment time by sequencing CAQH ProView, primary-source verification, and CMS 855 submission so…

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AI & AutomationCPT
Article · AI & Automation

When the short descriptor lies, read the long descriptor.

How CorePulse reads the operative note against full AMA CPT long descriptors to suggest the exact orthopedic code on foot and ankle procedures where…

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ASC & SurgicalNCCI
Article · ASC & Surgical

The bundling edits were already owned. CorePulse finally enforced them at the source.

How CorePulse enforces already-owned CMS NCCI PTP and MUE edits automatically at coding time, catching bundled pairs before submission instead of at…

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CredentialingEnrollment
Article · Credentialing

Enrollment to first dollar cut from 96 days to 41.

A multi-site behavioral health group cut enrollment-to-first-dollar from 96 to 41 days across 40 providers per quarter.

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CredentialingEnrollment
Article · Credentialing

ASP-RCM Case Study. Credentialing time cut from 110 days to 62.

How we shrunk BCBA payer enrollment from 90+ days to 22 days average across 6 commercial payers.

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Hospice & Post-AcuteLUPA
Article · Hospice & Post-Acute

Stop leaking revenue to LUPA. Re-sequence the visits, keep the full episode.

How a home health agency re-sequenced scheduled visits so each 30-day PDGM period cleared its per-HHRG LUPA threshold, converting low-utilization…

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Denials & ARDenials
Article · Denials & AR

Work the denials worth the money, not the oldest ones in the queue.

RecoveAR scores every denial by expected recovered dollars against effort and appeal deadline, so your team works the highest-yield denials first…

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Dental & Oral Surgery$1.7M
Article · Dental & Oral Surgery

Days in AR from 73 to 42. $1.7M of aged dental AR recovered.

14-location DSO cut days in AR from 73 to 42 and recovered $1.7M of aged Medicaid dental AR. CDT integrity, carve-out routing, recoupment defense.

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Dental & Oral SurgeryWaterfall
Article · Dental & Oral Surgery

Gross collection lies. Net collection tells the truth.

Gross collection is depressed by expected PPO write-offs, so net collection is the true dental measure. See the money-map waterfall, a 12-KPI dental…

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Coding & ComplianceModifier
Article · Coding & Compliance

One modifier. Six figures. The E/M revenue hiding inside same-day biopsies.

How a dermatology group recovered separately identifiable E/M revenue on same-day biopsy and destruction encounters using modifier 25, the…

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FQHC & CommunityPPS
Article · FQHC & Community

Engagement Pattern: How FQHCs get their PPS wraparound right.

What a typical PPS rate report and wraparound reconciliation install looks like for a 330-grant FQHC running multi-MCO contracts.

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FQHC & CommunityFQHC
Article · FQHC & Community

Wrap reconciliation rebuilt. NCR replaced GCR. Cash showed up.

How an urban FQHC network rebuilt Medicaid wrap reconciliation on the PPS rate, remapped its sliding fee schedule, and moved reporting from GCR to…

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FQHC & Community$2.1M
Article · FQHC & Community

Two years of wrap recovered. $2.1M in eleven weeks.

A 7-site FQHC network recovered $2.1M of unpaid Medicaid wrap in 11 weeks by reconciling member encounters against the published PPS rate. Full…

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HCC & RiskRecapture
Article · HCC & Risk

Recapture the conditions already in the chart. Then prove them.

A MEAT-based model for recapturing chronic conditions that live in the record but never hit a claim this year, gated on documentation that survives…

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HCC & RiskHCC
Article · HCC & Risk

The codes moved. The weight moved with them.

A side-by-side comparison matrix of how diabetes and vascular conditions remap from CMS-HCC V24 to V28, so your documentation and coding target the…

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HCC & Risk100%
Article · HCC & Risk

CY2026 is the first year your RAF runs on 100% V28, with zero V24 weight left to cushion it.

CY2026 is the first year the CMS-HCC V28 model runs at a full 100% blend with zero V24 weight. Here is how the recalibration moved RAF across…

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HCC & RiskRAF
Article · HCC & Risk

Average RAF lifted from 0.90 to 1.00. Every point documented.

How a Medicare Advantage panel lifted average RAF from 0.90 to 1.00 under CMS-HCC V28 using suspect identification, recapture, and MEAT discipline.

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Hospice & Post-AcuteHIS
Article · Hospice & Post-Acute

Your hospice already stopped filing HIS. The question now is whether HOPE and your claims still tell the same story.

A visual FY2026 readiness map for hospices moving off HIS to the HOPE assessment tool. See how to sequence HOPE timepoints alongside level-of-care…

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Hospital & Health SystemsDenials
Article · Hospital & Health Systems

Engagement Pattern: How hospitals bring denial rates back down.

What a typical denial reduction engagement looks like for a community hospital or critical access hospital with a denial rate climbing past industry.

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Hospital & Health Systems$4.8M
Article · Hospital & Health Systems

DNFB compressed from 11 days to 4. $4.8M cash unlocked.

Critical-access 280-bed hospital compressed Discharged Not Final Billed (DNFB) from 11 days to 4 days, unlocking $4.8M of working capital.

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Denials & ARAR
Article · Denials & AR

Rescuing legacy AR after a vendor change, without re-aging the book.

How RecoveAR rescues inherited legacy AR after a vendor change by importing the book on its original service dates, preserving Medicare, Medicaid,…

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CredentialingTelehealth
Article · Credentialing

One lapsed license should never silently switch off billing in a whole state.

How a telehealth group used Credential OS to track every provider's license and payer enrollment status per state, so a lapsed license in one state…

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ASC & Surgical59400
Article · ASC & Surgical

When the Global OB Package Breaks: Billing Split Maternity Care and 12-Month Postpartum Medicaid

When to unbundle the global obstetric package (59400 to 59622) into antepartum, delivery, and postpartum components when maternity care crosses…

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Therapy & RehabKX
Article · Therapy & Rehab

The KX threshold and the CO modifier, working together

How OT clinics apply the CY2026 KX modifier threshold ($2,480) and tag OTA-delivered minutes with the CO modifier (85 percent) so medically necessary…

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Dental & Oral SurgeryBill
Article · Dental & Oral Surgery

Bill the dental clearance before chemo as medical, and it stops getting denied as routine.

A field checklist for billing pre-chemotherapy and pre-transplant dental clearance as a covered medical service under the CMS CY2023-2026 Medicare…

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Coding & ComplianceJW
Article · Coding & Compliance

Zero-Waste Reporting: cleaning up JW and JZ modifiers on every single-dose vial

How an oncology practice cleaned up JW discarded-drug and mandatory JZ zero-waste modifiers on single-dose vials so every Part B drug line clears and…

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Ophthalmology92002
Article · Ophthalmology

Eye Codes vs E/M: An Ophthalmology Group's Code-Selection Fix for Retina Injections

How a retina-heavy ophthalmology group stopped losing office visits to injection bundling. A practical guide to choosing 92002-92014 vs 99202-99215…

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Coding & ComplianceModifier
Article · Coding & Compliance

Who owns the global days when the surgeon and the follow-up provider are not the same person?

How an orthopedic group rebuilt its global surgical package billing using modifiers 54 and 55 so the operating surgeon and the follow-up provider…

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Denials & ARLCD
Article · Denials & AR

Stop the denial before the needle, not after the claim.

How a pain practice builds front-end frequency and level-count guardrails against Medicare facet and epidural injection LCD limits, so procedures are…

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Denials & AR$1.2M
Article · Denials & AR

ASP-RCM Case Study. Parity-act underpayment recovery: $1.2M across 24 months.

Identifying and recovering parity-act underpayments for a behavioral health network with a structured payer-by-payer audit.

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Denials & AR4.1%
Article · Denials & AR

Three vendors missed it. We found 4.1% of net revenue.

Underpayments post as paid and close. How expected reimbursement loading and 835 variance analysis recovered 4.1 percent of net revenue for a group.

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ABA & AutismABA
Article · ABA & Autism

Two disciplines, one roof, five rulebooks that never overlap

How an employee-owned, multi-state pediatric therapy and special-education group bills ABA and physical therapy on one EMR across five funders, five…

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Payer & PolicyVaccines
Article · Payer & Policy

VFC vaccines and admin fees, mapped across your Medicaid lines

How a multi-state pediatric group bills $0 for VFC-supplied vaccine product while correctly capturing each state's set administration fee across…

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Coding & ComplianceReconcile
Article · Coding & Compliance

Split the claim before the discount stacks, then reconcile net against point-of-sale pricing.

How a specialty pharmacy splits 340B-eligible from non-eligible dispenses to stop duplicate discounts, then reconciles net revenue against CMS…

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Therapy & RehabKX
Article · Therapy & Rehab

The 8-Minute Rule, Recalculated

Turn total timed minutes into correct billable units, then tag the KX threshold and CQ assistant modifier so units and modifiers finally agree.…

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Denials & AR$1.86M
Article · Denials & AR

Systematic underpayments. $1.86M recovered in 12 months.

28-provider Texas multi-specialty group recovered $1.86M in underpayments: contract variance, modifier integrity, timely filing, credentialing holds.

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Denials & ARMPPR
Article · Denials & AR

Where MPPR should reduce your second imaging service, and where it absolutely should not.

How a radiology group audited its same-session imaging claims against the CMS Multiple Procedure Payment Reduction rules, catching both MPPR applied…

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CredentialingPSV
Article · Credentialing

A provider falls out of network the day a re-cred date slips. Build the calendar backward instead.

A Credential OS infographic checklist for driving the recredentialing primary source verification cycle off automated PSV and attestation reminders,…

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Hospital & Health SystemsLabor
Article · Hospital & Health Systems

We do not add labor to the revenue cycle. We add intelligence.

How academic medical centers and large health systems win the revenue cycle by adding intelligence, not headcount. The 4-A model, a…

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Hospital & Health SystemsCollections
Article · Hospital & Health Systems

ASP-RCM Case Study. The collection rate ceiling no other vendor would model.

A rural critical access hospital was being pitched a 15 percent gross collection rate target by a competing RCM vendor.

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Coding & ComplianceS9083
Article · Coding & Compliance

Bill S9083 or bill per visit? The answer lives in the contract, not the chart.

How a multi-site urgent care network maps every payer contract to one billing method, global S9083 for capitated payers or itemized E/M 99202-99215…

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Therapy & RehabSLP
Article · Therapy & Rehab

SLP threshold and AAC evaluations, coded so the device claim actually pays.

A speech clinic's coverage-and-coding fix for the SLP therapy threshold and AAC speech-generating-device evaluations, so device claims are supported…

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Hospital & Health Systems$3.1M
Article · Hospital & Health Systems

Per diem up $47. $3.1M recovered across three buildings.

Three-facility Southeast SNF group recovered $3.1M through PDPM case-mix integrity, Part A/B separation, consolidated billing, and MA auth tracking.

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Hospital & Health SystemsSNF
Article · Hospital & Health Systems

Mapping the Primary Diagnosis Right: A SNF's PDPM Case-Mix and ICD-10 Cleanup

How a skilled nursing facility fixed its admitting primary diagnosis and PDPM ICD-10 clinical-category mapping so case-mix components reflected the…

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ABA & Autism35%
Article · ABA & Autism

ASP-RCM Case Study. From 35% denials to single digits in two billing cycles.

How a solo BCBA practice went from a 14% denial rate to 3.2% in 6 months without changing EMR or hiring.

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Coding & ComplianceG2211
Article · Coding & Compliance

Set one rule for the split/shared visit. Attach G2211 the same way every time.

One enterprise rule for who bills the split/shared visit and when G2211 attaches, so 60 providers across specialties stop applying conflicting logic…

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Behavioral Health$1.62M
Article · Behavioral Health

$1.62M of denied AHCCCS claims recovered in 90 days.

Multi-site Arizona SUD provider recovered $1.62M of denied AHCCCS claims in 90 days. Per-diem integrity, auth-to-LOC alignment, TIN/NPI cleanup.

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Therapy & Rehab$809K
Article · Therapy & Rehab

Authorization leakage cut from $809K to $85K a year.

22-clinic PT/OT/SLP group recovered $724K of auth-driven leakage: visit-limit tracking, 8-minute rule units, POC recerts, ABN discipline, MA prior…

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ASC & SurgicalASC
Article · ASC & Surgical

Total joints moved outpatient. Your billing has to move with them.

A vertical-timeline operator's guide to moving total hip and knee arthroplasty into the ASC: sequencing the billing, device-intensive payment, and…

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Coding & ComplianceOPPS
Article · Coding & Compliance

The scope stayed the same. The place-of-service code was quietly costing them.

How a urology group stopped losing money on in-office cystoscopy and UroLift by fixing place-of-service coding, with real CMS PFS, OPPS/ASC CY2026…

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HCC & Risk$5.8M
Article · HCC & Risk

V28 recapture lifted RAF by +0.14 and pulled $5.8M PMPY back.

Medicare Advantage practice with 4,000 attributed lives added +0.14 RAF and captured $5.8M PMPY in 90 days.

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AI & AutomationVOB
Article · AI & Automation

The 271 came back thin. Now what?

How VoiceIQ clears verification of benefits when a payer only answers by phone or IVR, then feeds structured VOB straight back into the front-desk…

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AI & AutomationAuth
Article · AI & Automation

Your staff should never wait on hold to hear "still pending."

How a specialty practice used VoiceIQ voice automation to take staff off hold for prior-authorization status calls, bridging the gap before…

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AI & AutomationComes
Article · AI & Automation

When the 277 Comes Back Empty: Voice Follow-Up on Stuck Claim Statuses

When the electronic 277 response is missing or ambiguous, ASP-RCM VoiceIQ places automated voice claim status follow up calls to capture a real…

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Denials & ARAR
Article · Denials & AR

Sort the AR worklist by days to the filing deadline, not by dollars.

How RecoveAR re-sorts the AR worklist by days-to-timely-filing-deadline, not balance, so recoverable claims get worked before the payer window closes.

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Featured engagements

Three different shapes. The same ASP-RCM playbook.

Solo BCBA, mid-market group, multi-state expansion. Senior ASP-RCM partner-led on every account.

Pattern · TherapyAuth
Engagement pattern · outpatient PT/OT/SLP

Therapy Group: Authorization Leakage Closed Across 22 Clinics.

A Midwest PT, OT, and SLP group stopped authorization-driven revenue leakage through visit-limit tracking, 8-minute rule unit integrity, and plan-of-care recertification timing. Read the therapy authorization turnaround case study.

Read the therapy authorization case study
Pattern · Dental DSOAR
Engagement pattern · multi-location DSO

Dental DSO: Aged Medicaid AR Turned Around Across 14 Locations.

A mid-Atlantic dental service organization cleared aged Medicaid AR through CDT coding integrity, carve-out payer routing, per-location credentialing, and recoupment defense. Read the dental Medicaid AR turnaround case study.

Read the dental Medicaid AR case study
Pattern · SNFPDPM
Engagement pattern · skilled nursing

SNF Group: PDPM Case-Mix Integrity Frees $3.1M.

A three-facility skilled nursing group recovered trapped cash through PDPM component accuracy, Medicare Advantage authorization tracking, and consolidated billing discipline. Read the SNF PDPM cash recovery case study.

Read the SNF PDPM case study
Pattern · SUDAHCCCS
Engagement pattern · behavioral health SUD

SUD Provider: AHCCCS Denials Recovered at 70%.

A four-site Arizona SUD provider recovered denied AHCCCS claims by aligning level-of-care billing, per diem integrity, and prior authorization to ASAM criteria. Read the AHCCCS denial recovery case study.

Read the AHCCCS denial case study
Pattern · Physician Group$1.86M
Engagement pattern · multi-specialty group

Physician Group: $1.86M of Payer Underpayments Recovered.

A 28-provider multi-specialty group recovered systematic payer underpayments through contract-to-payment variance analysis, modifier integrity, and timely-filing rescue. Read the payer underpayment recovery case study.

Read the underpayment case study
Pattern · ABA Chain3-Way
Engagement pattern · multi-state ABA

ABA Chain: Three-Way Match Recovers $3.1M Cash.

A multi-state ABA chain stopped revenue leakage with the ASP three-way match of authorization, supervision, and documentation. Denials fell from 18.6% to 5.9%, aged AR cleared, and $3.1M of cash was recovered over six months.

Read the case study
Pattern · FQHCWrap
Engagement pattern · urban FQHC network

FQHC Wrap Reconciliation Lift, NCR the Right Lens.

An urban FQHC network under-collected Medicaid wrap and mis-stated collections on GCR. ASP-RCM rebuilt wrap reconciliation on the PPS rate and moved reporting to NCR.

Read the case study
Pattern · HCCRAF
Engagement pattern · MA primary care

V28 RAF Recapture: 0.90 to 1.00 on 12,000 Lives.

A Medicare Advantage primary care group lifted average RAF from 0.90 to 1.00 under CMS-HCC V28. Suspect ID, annual recapture, and MEAT discipline, fully compliant.

Read the case study
Pattern · CredentialingCred
Engagement pattern · behavioral health group

Enrollment to First Dollar Cut From 96 to 41 Days.

A multi-site behavioral health group cut enrollment-to-first-dollar from 96 to 41 days across 40 providers per quarter. Credentialing-hold AR released, revalidation lapses stopped.

Read the case study
Pattern · Multi-specialtyVariance
Engagement pattern · multi-specialty group

Payer Underpayment Recovery: 4.1% of Net Rev Found.

Multi-specialty group had three prior vendors miss underpayments. ASP-RCM loaded expected reimbursement, found systematic contract variance, and recovered 4.1% of net revenue through 835 remit analysis and targeted appeals.

Read the case study
Rural CAH · Western US9.5%
$222M+ gross charges · pre-engagement DD

The collection rate ceiling no other vendor would model.

A rural critical access hospital was being pitched a 15 percent GCR target. We audited their actual data and modeled a realistic 9.5 percent ceiling. Leadership picked the middle scenario. Six months in, they are hitting the commit.

Read case study
Mid-Market · FL/GA$640K
7-clinic ABA group · 90-day case

$640K recovered from aged AR in the first 120 days.

A 7-clinic ABA group across Florida and Georgia inherited a 50-day AR aging problem from a generic billing vendor. We rebuilt the auth workflow, cleaned up legacy denials, and stabilized cash velocity.

Read case study
Growth · Multi-state62d
Multi-state expansion · 40 new clinicians

Credentialing time cut from 110 days to 62.

A growing ABA network needed to onboard 40 new BCBAs and RBTs across three new states without losing 90 days of billable revenue per hire. Here’s how the parallel-workflow approach compressed it.

Read case study
Solo BCBA · TX35%
Single-owner clinic · Texas Medicaid + commercial

From 35% denials to single digits in two cycles.

A single-owner BCBA was doing billing at 9pm after sessions. Two billing cycles later, the denial rate was below 8%, and she had her evenings back.

Read case study
Behavioral HealthP2P
Multi-site outpatient psych · 14 locations

Parity-act underpayment recovery: $1.2M across 24 months.

A 14-location outpatient psych group suspected they were being underpaid by two MCO carriers. A line-by-line fee-schedule audit confirmed it. Recovered, with interest.

Read case study
Authorization99%
Mid-market ABA · 18-month engagement

99.4% on-time re-authorizations across 142 active clients.

What a daily payer-portal sweep, a unit-utilization dashboard, and a dedicated auth desk look like in practice. Plus the dollar value of the gaps we caught.

Read case study
Audit Defense24h
FL Medicaid audit · $4.8M at risk

$4.8M audit closed with zero clawback in 24 hours.

State Medicaid audits don’t care that you’re busy. When the request came in, our audit-ready vault produced the chart-pull and response packet inside one business day.

Read case study
Pattern · ABA ChainPattern
Engagement pattern · multi-site ABA

How ABA chains lift commercial collections.

What a typical commercial-payer recovery engagement looks like for a multi-site ABA chain moving from generic billing to specialty-aware RCM. Industry-benchmark ranges, not a single client.

Read the pattern
Pattern · FQHCPPS
Engagement pattern · 330-grant FQHC

How FQHCs get their PPS wraparound right.

What a typical PPS rate report install and wraparound reconciliation engagement looks like for a 330-grant FQHC running multi-MCO contracts. Industry-benchmark ranges, not a single client.

Read the pattern
Pattern · HospitalPattern
Engagement pattern · community / CAH

How hospitals bring denial rates back down.

What a typical denial reduction engagement looks like for a community hospital or critical access hospital with a rising denial rate. Industry-benchmark ranges, not a single client.

Read the pattern

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