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Case Studies
Orthopedic Group in Nevada
Overview
- Privately held Orthopedic group in Nevada
- Specialty: Orthopedic (Joint Replacement, Spine Care, Pain Management, Physical Therapy, Open MRI, Trauma Fracture Care, Upper Extremity Surgery, Sports Medicine, Etc.)
- Over 50 years of history of providing the highest quality orthopedic services for patients throughout Nevada
- Clients’ Revenue per year > $20M (2020)
Implementation
- Daily claims submission
- Quarterly coding audits and constant auditing of coding by in-house CPC coders
- Weekly discussions with front staff to review Prior Authorization Denials
- Improved payment turnaround time through proper eligibility checks and escalation of un-insured patients prior to the appointment date
- Fix denials within 48 hours
- Follow up date based collection follow ups and daily follow on denials
- Aggressive follow up on claims passed 150 days from Date of Service
- Real-time Analytics reports (DOCTRIX®)
- Weekly progress reports
- Monthly Revenue analysis report
- Quarterly Onsite Strategy Discussions
- Quarterly Discussions with Providers
- Best Practices recommendations
Challenges
- An average of a 12-day delay in surgery claim submission
- Non-specific coding and lack of documentation (Non-compliant coding related to E & M, Bundling issues)
- Not Securing Prior Authorization for required services resulting in loss of revenue
- Increased eligibility related denials
- Increased denials related to Physical Therapy Cases
- Lower first time payment rate
- Higher zero pay CPT%
- Poor transparency to overall and individual performance of providers
Results
- Billing turnaround time improved from 7 to 4 days
- Seamless transition to new improved Practice Management System helping with the coding and documentation challenges
- Reduction in the 90+ Insurance AR from 40% to 15%
- Reduction in the Days in AR from 49 Days to 25 Days
- Clean Claim rates improved to 99%
- Consistently maintained Zero pay claims at less than 2%
- Resolved claim % at 90 and 120 days is 99%
- 100% transparency into RCM processes
- Best in class & compliant business processes
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Disclaimer: Results shared on this website are the average performance of SYNERGEN Health clients. Results may vary by systems and processes.
RESOURCES
Comprehensive State of Denials Management in 2026
Healthcare denials are evolving fast due to payer automation, rising complexity, and new technologies reshaping revenue cycle management. This white paper explores why denial categories look the same but are harder to manage and what will define denials management in 2026.
