Client Profile
- Type: Specialty Hospital
- Specialty: Orthopedic and Surgical Care
- Capacity: 150 beds
- Annual Patient Volume: Approximately 65,000
About The Client
Located in the Southeast region of the United States, this specialty hospital is known for its advanced orthopedic care and surgical expertise. With a capacity of 150 beds and a high volume of complex procedures, the hospital serves a diverse patient population requiring precision in clinical documentation and billing. Despite its clinical reputation, the hospital’s revenue cycle operations were under strain due to the intricacies of orthopedic coding and evolving payer regulations.
Challenges
The hospital faced several operational and financial challenges:
- High coding error rates due to complex orthopedic and surgical claims
- Compliance risks triggered by frequent audits and billing inconsistencies
- Delayed reimbursements, with AR days averaging 60
- Overburdened coding staff, unable to keep pace with growing case volumes
The leadership team recognized the need for a compliance-first, automation-enabled revenue cycle strategy to protect revenue and reduce staff burnout.
ImpactRCM’s Approach
To address these challenges, the hospital partnered with ImpactRCM, leveraging its AI-powered platform to bring precision, automation, and regulatory alignment to its revenue cycle operations.
Key Components:
AI-Assisted Orthopedic Coding
Real-time chart reviews improved coding accuracy and reduced human error
Compliance Safeguards
AI-driven rules checked every claim against payer policies and regulatory requirements
Denial & AR Automation
Automated denial workflows and AI follow-ups reduced rework and accelerated reimbursements
Performance Dashboards
CFO-level analytics provided visibility into coding accuracy, AR trends, and denial recovery
Results After 8 Months
| Performance Indicator | Before ImpactRCM | After ImpactRCM |
|---|---|---|
| Accounts Receivable Days | 60 | 40 |
| Coding Accuracy | 87% | 97% |
| Denial Recovery | Manual, slow | $1M+ recaptured annually |
| Staff Workload | High | 35% reduction in coder burnout |
Potential outcomes
- Improved audit readiness and reduced compliance risk
- Faster reimbursements and stabilized cash flow
- Enhanced coder retention and morale
- Revenue leakage minimized through automation
Conclusion
This case study illustrates how ImpactRCM’s intelligent RCM platform can help specialty hospitals overcome coding complexity and compliance challenges. By integrating AI-assisted coding, automated denial management, and real-time analytics, ImpactRCM enabled this orthopedic hospital to regain financial stability and scale operations confidently.
