Achieving 94% Claim Rate: People, Process, and Ownership
Key Results Achieved
annual claim rate achieved in under 12 months
reduction in claim resubmissions and denial management overhead
faster reimbursement cycles improving cash flow predictability
The Challenge: Inconsistent Claim Accuracy and Escalating Rework
Claim rate directly impacts reimbursement timelines, reduces administrative rework, and improves cash flow. Yet many healthcare organizations struggle to consistently reach above 90% claims, especially with complex billing workflows across multiple payers and systems.
When we began this engagement, the client's claim rate fluctuated below industry standards. Internal staff were overwhelmed. No structured performance management existed.
The client needed stability, predictability, and reliable results.
When we began this engagement, the client's claim rate fluctuated below industry standards. Internal staff were overwhelmed. No structured performance management existed.
The client needed stability, predictability, and reliable results.
The Pharmbills Approach:
People First
People First
We believe clean data starts with capable, accountable people supported by smart processes and continuous improvement.
From day one, we took ownership over building and managing the RCM operation from the ground up.
From day one, we took ownership over building and managing the RCM operation from the ground up.
01
Staffing with
Purpose
Purpose
We selected professionals with strong technical RCM backgrounds and the mindset to thrive in high-accountability environments. We build high-performing teams that act like stakeholders, not contractors.
02
Structured Onboarding and Custom Training
Each team member completed onboarding tailored specifically to the client's systems, processes, and payers. We designed training around their business, not generic templates.
03
Complete Management Structure
Pharmbills built the entire management framework: defined KPIs, daily QA review processes, weekly performance scorecards, and transparent client reporting. Our management layer ensures consistency with zero client overhead.
04
Continuous Feedback and Refinement
We established tight feedback loops with client leadership and our internal QA team. Monthly reviews identified performance patterns, flagged recurring issues, and adapted workflows. Every insight became action. Every error became a learning opportunity.
The Outcome:
Sustained High Performance
Today, our team oversees multiple facilities, manages complex payer interactions, and operates as a fully embedded part of the client's revenue cycle.
Achieving 94% claim rate requires more than software or documentation. It requires the right team, purpose-built training, and active management. That's what Pharmbills delivers.
Achieving 94% claim rate requires more than software or documentation. It requires the right team, purpose-built training, and active management. That's what Pharmbills delivers.
Ready to improve your claim rate?
Contact us to discuss your specific challenges and our proven approach.
Do you want to develop your custom solution?
Table of Contents
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Brandon Bolnick
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