How a California-Based Multi-Speciality Hospital Transformed its RCM by 30% with 24/7 Medical Billing Services Support

A well-established multi-speciality hospital in California was facing significant challenges in managing its Revenue Cycle Management. With several departments, such as cardiology, orthopaedics, oncology, neurology, and internal medicine working simultaneously, the hospital had a complex clinical structure and a high patient volume.

Although the hospital had an experienced in-house billing and coding team, they struggled to manage the growing intricacies of multi-speciality billing, frequent insurance updates, and the rising administrative workload across departments. These obstacles resulted in delayed payments, increased claim denials, and reduced visibility into departmental performance, with an impact on the overall financial health of the hospital.

To deal with these issues, the hospital decided to partner with 24/7 Medical Billing Services, professional RCM company known for delivering speciality-aware, compliant, and tech-enabled billing solutions. Within 1 year of partnership, the hospital experienced a 30% improvement in overall revenue performance. This proves the worth of expert support in a multi-speciality healthcare operation.

Background: A Need for End-to-End Revenue Cycle Support

The hospital previously followed a fragmented billing approach. The various speciality departments handled different RCM functions separately without proper coordination or central oversight. This disjointed setup usually resulted in delays, miscommunication, and avoidable errors.

In-house teams were already overburdened and unable to dedicate time to follow up on denied claims or late reimbursements. The absence of the latest advanced tools to consolidate billing data across departments made it challenging to analyze performance and identify revenue leakages. These gaps result in:

• Slower reimbursements, especially in high-value specialities
• Frequent claim rejections due to inconsistent coding and incomplete documentation
• Revenue leakage in procedures involving multiple specialities
• Lack of visibility into revenue performance by speciality, making financial planning more difficult

The hospital executives recognized that they required a centralized, technology-enabled, and expertly managed RCM process

 to remain competitive and financially strong.

Challenges

The hospital faced revenue management problems across all key stages of the revenue cycle. It included:

• Patient Access Issues

The patient access errors had ripple effects throughout the revenue cycle, especially where patients often receive treatment from multiple specialities during a single visit.

• Patient details, such as insurance information, date of birth, or visit purpose, were sometimes captured inconsistently across departments.
• Staff members often missed collecting co-pays or deductibles during visits involving multiple specialities.
• Insurance verification was not always completed in real-time, especially for specialized treatments that required pre-authorization.

These problems led to billing delays, denied claims, and confusion for patients receiving care from multiple departments in the same hospital visit.

• Mid-Revenue Cycle Gaps

The middle phase of the revenue cycle, i.e., clinical documentation, coding, and charge capture, was vulnerable in this hospital.

• Physicians across specialities documented procedures differently, leading to incomplete or inconsistent records.
• Coding errors were common, especially in cases involving overlapping codes between specialities (e.g., cardiology and pulmonology).
• Manual charge entry led to missing charges, especially when a patient received services from multiple departments on the same day.

This created undercoding, billing inaccuracies, and interdepartmental revenue loss.

• Patient Financial Services (Back-End) Issues

This phase includes claim submission, denial management, and collections.

• Claims involving multiple specialities often had documentation mismatches, leading to rejections.
• The hospital’s internal billing team lacked the resources to follow up on all denied or delayed claims, particularly when specialized codes or modifiers were involved.
• There was no central system to track denials across departments, resulting in recurring issues that went unresolved.

This inefficiency in the back-end process led to longer accounts receivable cycles, slower cash flow, and missed recovery opportunities.

Solution: Partnering with 24/7 Medical Billing Services

To tackle these challenges, the hospital outsourced its entire RCM operations to 24/7 Medical Billing Services. With experience in multi-speciality billing, the company brought in a team trained to handle speciality-specific codes, payer requirements, and departmental workflows.

The first step was a comprehensive audit of the hospital’s RCM process, identifying pain points unique to each department. Based on this, 24/7 designed a “Patient-to-Payment” strategy tailored to multi-speciality workflows, ensuring that billing was accurate, timely, and fully compliant across all departments. Such a strategy leads to:

• Enhanced Patient Access Workflow

24/7 Medical Billing Services improved the front-end processes across all departments, ensuring patient data was correctly captured and insurance eligibility verified at the point of entry.

• Centralized registration with uniform data collection protocols
• Real-time eligibility checks and benefit verification for all departments
• Pre-authorization tracking for speciality-specific treatments
• Upfront POS collection for co-pays and deductibles, even across multiple specialities
• Clear communication with patients regarding their financial responsibilities

This helped reduce front-end errors and significantly lowered eligibility-related denials.

• Speciality-Aware Clinical Documentation and Coding

Every speciality has its own documentation and coding complexities. 24/7 Medical Billing Services provided support and training to ensure that all physicians documented procedures thoroughly and in accordance with the payer's expectations.

• Speciality-specific documentation templates to ensure completeness
• On-site and virtual training for providers in departments like cardiology, neurology, and orthopaedics
• Coding audits to align with ICD-10, CPT, and HCPCS codes updates
• Accurate use of modifiers and bundled codes for multi-speciality cases

As a result, claim accuracy improved across all departments, and undercoding was reduced.

• Automated and Accurate Charge Capture

Charge capture was optimized to handle multi-department procedures efficiently.

• EHR-integrated charge entry ensured that all services were captured in real time
• Automated alerts reduced duplicate or missed entries
• Speciality-specific charge sheets helped maintain consistency

This allowed the hospital to maximize revenue across all clinical services without losing charges due to manual oversights.

• Dedicated Denial Management and AR Follow-up

24/7 Medical Billing Services deployed a team focused solely on multi-speciality denial trends and high-value follow-ups.

• Denials were categorized and tracked by speciality
• Appeals were submitted with documentation tailored to specific departments
• A/R ageing was reduced through automated workflows and prioritization of speciality claims

This helped the hospitals accelerate reimbursements and restore previously written-off payments.

Implementation: A Smooth and Secure Process

24/7 Medical Billing Services made the transition easy by working closely with the hospital's clinical, in-house billing, and admin teams. Each department was onboarded step-by-step to make sure all processes matched the hospital's current system. The staff received clear training on new workflows and documentation methods, which helped them work more accurately and consistently across different specialties.

The team also used secure software that followed HIPAA rules to keep patient data safe. Real-time dashboards were set up to track how each department was doing. Such careful and systematic implementation helped maintain continuity in hospital operations without any disruptions.

Results: 30% Improvement in Revenue Cycle

Within a year of working with 24/7 Medical Billing Services, the multi-speciality hospital experienced significant results.

• 30% boost in the overall revenue cycle performance across all departments
• 37% drop in claim denial rates, especially for cross-speciality procedures
• 95% clean claims rate, improving first-pass acceptance
• Faster reimbursement cycles for high-cost treatments
• Greater financial transparency and reporting by the department

Staff also experienced reduced administrative stress, allowing for a better focus on delivering coordinated, high-quality care.

Conclusion: A Smart Step Toward Stronger Financial Health

This case study shows how a multi-speciality hospital can benefit from working with an experienced RCM partner. Billing across different departments can be complex and needs a well-planned, centralized system supported by smart technology.

The California-based hospital improved its overall revenue cycle by partnering with 24/7 Medical Billing Services. With expert support, each department achieved improved financial performance and reduced billing issues.

The hospital also built a more stable and sustainable financial system through this partnership. The tailored 'Patient-to-Payment' model used by 24/7 MBS played a key role in making processes smoother and more efficient. This allowed the hospital to focus on what matters most, i.e., providing excellent care, while keeping its revenue system strong, compliant, and ready for the future.

Note: The name of the California-based multi-speciality hospital has been withheld for security reasons.