Roshan

You’ve done the work. The care was delivered, the claims were submitted but the money still isn’t in the bank. If you lead revenue cycle for a community health center, you know this feeling all too well. Claims hit 60, 90, even 120 days old with no resolution. Payer silence, documentation gaps, and write-offs become the norm. The backlog builds. And suddenly, your team is spending more time chasing old dollars than collecting new ones. Sound familiar? Why It Happens – and Why It Doesn’t Have To A/R aging isn’t just a back-end problem. It’s a symptom of deeper misalignment: Claims go out without required documentation Eligibility wasn’t fully confirmed up front Follow-up is inconsistent or outsourced without oversight Denials aren’t tracked or trended, just refiled And in community health, where margins are razor-thin, that lag can mean delayed hires, missed expansion goals, or worse, reduced patient access. We’ve worked with FQHCs and community clinics with over $1.2M in 90+ A/R and no real idea where the breakdowns started. We don’t throw tools at the problem. We get inside the workflow and fix it. Our Cleanup Model: Human Oversight + Smart Workflows At Scionis RCM, we approach A/R cleanup like a forensic audit and recovery plan. Step one: Get clear visibility into aging buckets payer mix, denial types, recurring patterns. Step two: Prioritize clean-up based on yield, write-off risk, and contract timelines. Step three: Build or retrain workflows to prevent the same A/R from returning. Our team brings trained A/R recovery specialists not generalists who know payer logic, Medicaid quirks, and how to fix aging without overwhelming your front office. And every week, you’ll see where we’ve moved the needle claim by claim through a transparent, audit-ready dashboard. What a Community Health Group Saw in Just 90 Days One CHC we worked with had over $900K in unresolved A/R above 90 days. After just 12 weeks: $412,000 recovered from aged claims Medicaid-related denials cut by 37% 22% reduction in avoidable write-offs Aging A/R over 120 days dropped from 46% to 19% The difference wasn’t in the billing system it was in the follow-through. Final Takeaway You can’t keep moving forward if old claims are weighing you down. A/R cleanup isn’t glamorous but it’s one of the fastest ways to restore financial control in community health. We’ll help you get caught up, and more importantly, stay ahead. Case Study: Reclaiming $400K+ in Aging A/R for a Community Health System Summary A five-site community health organization reduced aging A/R over 90 days by 54% and recovered over $400K in outstanding revenue in under three months without disrupting ongoing billing operations. Client Background This federally qualified health center (FQHC) served underserved populations across five locations. With over 22,000 annual visits and high Medicaid volume, their internal billing team was stretched. Old claims were falling behind, and A/R was stacking up without a clear recovery plan. Key Challenges $900K+ in 90+ day aging A/R Medicaid and Medicare claims stuck due to auth and eligibility errors Denials being refiled without root-cause correction No tracking system for payer-specific follow-up Internal team overloaded with current claim volume Scionis RCM’s Recovery Plan Segmented aging A/R by payer and denial category Prioritized claims by yield and timely filing windows Rebuilt Medicaid eligibility documentation trail for retro-approval Implemented weekly cleanup reporting tied to cash impact Shared dashboards with leadership showing denial trends and financial lift Results Within 90 Days $412,000 recovered from aged A/R Denials reduced by 37% A/R >120 days reduced by 58% Write-off volume reduced by 22% Full audit log created for compliance and leadership transparency Client Quote “It felt like we were drowning in old claims. Now we’re actually seeing the money we earned months ago hit our books.” – CFO, Multi-site Community Health Center Closing Insight Revenue left unresolved is revenue lost. Community health centers need more than billing they need clean recovery. Our team brings it claim by claim, line by line. Want to work with us? Partner with Us to Drive Excellence Unlock your healthcare organization’s true financial potential with Scionis RCMs. We specialize in streamlining complex revenue processes, recovering lost revenue, and optimizing cash flow. With our expertise, you can focus on delivering exceptional patient care while we enhance your financial efficiency and growth. about us contact us Our Expertise

An Invisible Problem with Real Financial Consequences Anesthesia billing doesn’t fall apart in obvious ways. It fails quietly through missing minutes, unchecked modifiers, and documentation that can’t withstand payer scrutiny. Every missed time unit? Every incorrect QX or QZ? They don’t just delay payments they subtract from your bottom line. At Scionis RCM, we’ve seen this time and again across hospital-based groups, surgical centers, and CRNA-physician hybrids. You’re doing the cases. But the revenue? It’s not keeping pace. And it’s not because of low volume, it’s because of broken processes.   Where the Bleed Begins If your anesthesia group is losing revenue, it’s likely happening here: Start and stop times aren’t consistently captured or validated Modifiers like QX, QZ, QY are misapplied or missing entirely Base units and time units aren’t reconciled per payer-specific rules Concurrency and medical direction aren’t being documented to Medicare standards Anesthesia records and EMR entries aren’t being reviewed side by side One group we worked with was billing over 500 cases per month across three hospitals. Nearly 18% of their claims had either base unit discrepancies or modifier errors. That’s not minor inefficiency. That’s a silent leak in a high-volume pipeline. Our Hybrid Fix: Built for Surgical Speed, Not Billing Delay At Scionis RCM, we don’t ask you to change your EHR, billing system, or providers. Instead, we install a hybrid framework automation where it improves accuracy, human oversight where precision is non-negotiable. Here’s how we run anesthesia billing: Daily review of anesthesia records for documentation, direction, and concurrency Modifier logic engines applied before submission, validated by credentialed coders Time unit reconciliation down to the minute no estimates, no rounding errors Medicare direction logs tracked, flagged, and escalated as needed Weekly dashboards sent to leadership showing submission timelines, denial categories, and collection velocity This isn’t a theoretical fix. It’s operational structure that pays off. What Happened When One Group Made the Shift A regional anesthesia group came to us frustrated: “We’re slammed with cases but collections don’t reflect it.” Our discovery audit revealed: $210,000+ in missed revenue from unbilled or incorrectly timed cases High denial volume linked to modifier mismatches in team-based delivery 6-day average lag between date of service and claim submission Within 60 days of implementing Scionis’ workflows, they saw: 9.2% lift in collections without adding new tech 41% drop in modifier-related denials Coding lag reduced from 5.8 to 2.3 days 100% compliance on Medicare direction documentation   Before vs After Snapshot Metric Before Scionis After Scionis Time-unit accuracy 82% 98.7% Modifier-related denials 18.4% 10.8% Average submission lag 5.8 days 2.3 days Missed revenue per month $70,00+ Closed   Why It Works: Strategy, Not Software Too many billing vendors sell tools. But this isn’t a tech problem. It’s an execution gap. Scionis RCM provides: Automation where it increases precision (like modifier selection and unit capture) Expert humans where rules get complex (like direction logs and payer escalations) Reporting that makes performance visible, not just tracked, but improved And we do it all without asking you to rip and replace your platform. Final Takeaway: Stop Treating Time Like It’s Free Anesthesia billing fails when no one’s watching the clock or the codes. You don’t need more staff. You don’t need new software. You need a team that understands the rules, owns the process, and turns surgical volume into actual collections. At Scionis, we’ve helped anesthesia groups recover six-figures in missed revenue by simply realigning the workflows they already had. Let’s uncover what your OR volume isn’t capturing yet and how fast we can fix it.

Behavioral health revenue cycle challenges aren’t new but they’ve never been this broken. Clinics and mental health providers are navigating a system designed to fail them: bundled payments with unclear rules, Medicaid plans with state-by-state inconsistency, and a prior auth process so sluggish it delays care and stalls cash flow. The result? Thousands of dollars left uncollected every month, buried under red tape. The Brutal Truth: What Behavioral Health Clinics Are Really Losing Let’s be honest most behavioral health providers are flying blind when it comes to revenue cycle visibility. We’ve audited groups where: 28% of total Medicaid claims were denied on first submission Prior auth turnaround time averaged 11.6 days Bundled CPT logic was misapplied in over 1 in 5 encounters Eligibility was verified but not linked to documentation That’s not just operational drag it’s revenue bleeding. One multi-site practice left over $210,000 on the table in just one quarter due to missed or delayed Medicaid reimbursements. The Solution: Tech-Enabled, Expert-Led RCM At Scionis RCM, we don’t chase the latest platform trend. We build practical workflows that combine intelligent automation with real behavioral health billing experts. Here’s how we fix what others leave broken: Prior Auth Tracker: A real-time dashboard built for your clinic, not a black box. Weekly reports. Zero guesswork. Medicaid Eligibility Protocols: Aligned to plan-specific requirements, tied to state rules, validated by humans. Bundled Coding Workflows: Configured around service delivery, not just CPT logic. Staff-Level Alerts: Automated triggers that escalate delays before they hit A/R. GDPR & HIPAA-Compliant Data Handling: Because security and transparency aren’t optional. Our model knows where to automate and where to apply real human strategy. No bots pretending to be billers. No platforms replacing people. ROI: What Actually Changed for Providers Like You Our behavioral health clients aren’t just surviving they’re outperforming their peers: Denials reduced by 31% across Medicaid and commercial payers Prior auth time dropped to an average of 3.4 days $240K in recovered Medicaid payments in the first 90 days post-cleanup Front office staff time spent on auths cut by 45% 100% transparency via shared dashboards, weekly reporting, and audit trail logs CTA: Let’s Walk Through Your Process Let’s walk through your process. It’s a strategy conversation. If your behavioral health billing feels stuck, inconsistent, or invisible let’s map it out together.

Where Are Your Millions Stuck? If your finance or HIM leadership team is reviewing aging DNFB numbers without a plan to cut them down then you’re likely sitting on unreleased revenue. We’ve seen hospitals hold more than $6 million in unbilled claims simply because discharge coding workflows were broken or buried in internal silos. Charts are completed. Discharges are done. But the revenue? Stuck in limbo. This is the cash freeze no one talks about until your forecast misses. What’s Really Causing the DNFB Bottleneck? It’s rarely about coding capacity. Instead, DNFB piles up because: Clinical documentation is incomplete or unstructured CDI teams can’t resolve queries fast enough Coders lack discharge-specific workflows (ED vs psych vs inpatient) No real-time DNFB dashboard shows case status or revenue hold The outcome? Days, even weeks of revenue locked inside EMR systems waiting for action. What Our Teams Have Delivered for Hospital Partners In just 30 days, here’s what a regional system achieved with Scionis RCM: $3.1M in uncoded charts released and billed 66% faster coding turnaround (5.6 → 1.9 days) 72% of discharges required no secondary queries after workflow realignment 58% reduction in overall DNFB backlog volume GDPR + HIPAA compliant documentation audit for all charts billed Before vs After: Chart Lag to Claim Release Before: DNFB dashboard showed 320+ discharges older than 5 days with unclear status. After: Every uncoded discharge categorized query pending, provider delay, or coding complete. Result: 86% of charts moved to billing in under 48 hours post-coding. Client Outcome Snapshot A 250-bed acute care hospital with two coding teams and inconsistent CDI workflows had $6.4M in held revenue. Within 4 weeks of implementation, Scionis deployed a discharge-specific coding strategy, aligned queries to physician documentation timelines, and escalated unresolved delays daily. The hospital cleared more than half its backlog and booked over $3.1M in net new collections all while maintaining internal HIM continuity. Final Takeaway DNFB isn’t just a backlog it’s a liability. And until every discharge is final billed, your revenue is at risk. Scionis RCM delivers the oversight, structure, and specialty-aligned workflows hospitals need to move discharges to dollars fast, clean, and audit-ready.

When Imaging Moves Fast, but Revenue Moves Slow Radiology is one of the highest-throughput service lines in healthcare but the revenue cycle often lags days, even weeks, behind. Orders get lost in translation, CPTs get dropped during transmission, and coders aren’t always aligned to the modality they’re coding. You don’t need another platform. You need billing workflows that understand radiology logic. Because every missed CPT, every rejected claim, and every billing delay isn’t just noise it’s lost income. What’s Really Breaking in Radiology RCM? Across outpatient imaging centers and diagnostic departments, we’ve consistently seen: CPT mismatches for dual-modality and contrast/non-contrast studies Orders disconnected from clinical documentation or improperly linked Modifiers not applied or stripped out during RIS/PACS handoff No real-time visibility into where the claim sits between scan and billing Visual Snapshot – Revenue Leakage in Radiology Ordered Procedures: 100% Captured CPTs: 86% Clean Documentation Matched: 73% Submitted Claims (First-Time Clean): 62% Result: 38% of revenue was either delayed, denied, or undercoded How We Closed the Gap at Scionis Our approach to radiology billing isn’t just technical it’s operational: Modality-specific coders paired to each site and study type Live CPT capture audits from PACS feed Pre-bill CPT and modifier review logic tied to payer policy Workflow integration with RIS to validate orders before billing Shared dashboards showing time from scan to billing by location and case Quantifiable Results One regional imaging group saw the following in just 60 days: $310,000 recovered in missed CPT value 55% improvement in order-to-bill turnaround 36% drop in documentation-related denials Full compliance with HIPAA and GDPR across documentation trails Weekly reports shared with finance and operations Before vs After Snapshot   Closing Insight Every scan should turn into revenue. But in radiology, that only happens when the coding logic, the documentation, and the billing ops move as fast as the imaging. At Scionis, we bring operational clarity to the billing side of radiology because clinical efficiency means nothing if the revenue gets stuck in the backend.

When Surgical Precision Meets Billing Blind Spots Orthopedic surgery is precise. Billing for it? Not so much.Across ambulatory surgery centers, ortho practices, and specialty hospitals, the same pattern shows up: surgical procedures are performed, implants are used, but the billing capture falls short. And unlike a clinical error, the missed revenue doesn’t trigger alarms it just quietly slips away.If your collections don’t reflect your surgical volume, it’s not your volume it’s the RCM handoff. And that’s where the bleeding starts. The Real Cost of Missed Ortho Charges Surgical teams are focused on patient outcomes. But without tight back-end workflows, documentation gaps translate into dropped charges.Here’s what we’ve seen firsthand: Implant logs that never make it to billing Op notes delayed or incomplete, holding claims Prior auths missing or mismatched for hardware Modifiers omitted during claims submission In one orthopedic group, nearly 21% of surgeries had one or more missed billing elements averaging $720 lost per case. Over a quarter, that translated to over $180,000 in missed collections. What We Changed (and What Changed as a Result) At Scionis, we rebuilt the orthopedic billing logic from the ground up. Every surgical case is pre-validated for prior auth and hardware approval Post-op notes are tracked in a daily dashboard with real-time status Implant usage is matched against vendor logs and EMR entries Claims move within 48 hours of surgery with peer-review coding auditsThe result isn’t just better billing it’s billing that reflects the precision of orthopedic care. Results That Resonate With Ortho Execs $172,000 in missed revenue recovered in 90 days Denials dropped by 33% in surgical claim category Claims submitted 3.5 days faster post-op on average Full dashboard transparency shared with ops and clinical leads HIPAA + GDPR controls enforced across every billing file Client Impact Story A 12-provider ortho group across 3 locations realized that while surgical volume was climbing, collections weren’t. Our discovery audit found implant logging errors, miscoded post-op visits, and lagging documentation. We deployed our surgical coding team and billing ops analysts to overhaul the handoff. Within one quarter, they recovered nearly $200K in missed billing and built a claims tracking workflow the staff now relies on every week. Closing Thought Ortho groups know how to fix joints but your billing workflow needs surgery too. If revenue isn’t matching your OR schedule, let’s explore where the cracks are. We’ll show you what’s leaking, and how fast it can be sealed.