Key Results Achieved: Claim Recovery and Backlog Elimination
increase in claim rates
within 5 months
facilities successfully transitioned with zero operational disruption
Eliminated claim
rejection backlogs and accelerated payment timelines
Background Story
In healthcare finance, outsourcing isn't just about cost savings. It's about precision, continuity, and control. But when a BPO partnership fails, it leaves more than broken processes. It leaves doubt.
A mid-sized long-term care organization approached Pharmbills after their previous outsourcing experience failed. Poor communication. Delayed claims. Minimal accountability. Claim rates well below industry benchmarks.
By the time they contacted us, they were skeptical of the entire BPO model. But they needed help and agreed to try one more time.
Starting Over:
Performance Before Promises
We knew this relationship couldn't start with promises. It had to start with performance.
We didn't pitch solutions. We started small. We listened. We asked operational questions. We embedded a team into their systems and workflows. Then we delivered.
How We Approached the Challenge
Refining the Billing Process for Precision
We improved billing preparation to ensure accuracy before claim submission. We reviewed all billing data in context, checked for errors early, and eliminated rework downstream. Claims improved immediately.
Enabling Electronic Payments
Paper checks slowed everything down. We worked with the client to push payers toward electronic payments. Result: fewer delays, more predictability, better cash flow.
Bridging System Gaps
Miscommunication between tracking platforms was a major challenge. We implemented standardized workflows that connected systems, reduced duplication, and created clear information flow from intake to reimbursement.
Going Beyond Requirements
When documentation or medical records were missing, our team didn't stop at flagging issues. We retrieved the right information to keep claims moving. Simple concept, critical shift in mindset.
Performance Management That Works
Our teams complete rigorous onboarding customized to each client's workflows. We established feedback loops with quality reviews, targeted coaching, and incentive programs that reward progress, not just activity.
The Outcome:
From Skepticism to Partnership
Five months into the partnership, the numbers proved our approach worked. More importantly, we rebuilt trust.
The client, once burned by outsourcing, is now expanding our partnership. Performance drives trust. Trust enables growth.
