Untangling hospital eligibility gaps and BMT case-rate billing across 7 locations

Verified client

The challenge

This is a hospital-based infectious disease group with 4 providers working across 7 locations. Their hardest billing problem wasn't the payer count — it was the hospital itself. Getting timely, accurate eligibility information out of the hospital's systems was a constant bottleneck, and on top of that, the practice manages a complex web of BMT (bone marrow transplant) case-rate billing, one of the more specialized and error-prone areas in infectious disease coding. Most billing teams don't have the depth to handle it correctly.

The results

Measured by date of service, claims at least 120 days old, self-pay excluded.

96.4%

net collection rate across 80 different insurance plans

$1.27M

collected on about 10,000 visits

93%

of claims created within 3 days of the visit

2.8%

of collectible revenue written off

1.1%

of 2025 money still unpaid

hospital locations, one coordinated billing operation

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