Results

See how RCxRules is making a difference.

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HCC Coding
Revenue Cycle Rules

How ENT and Allergy Associates Automatically Corrects 82% of Their Claim Errors Since implementing the Revenue Cycle Engine, ENT and Allergy Associates has achieved an 82% automation rate, meaning staff only has to intervene on 18% of billing and coding issues. Learn more in this case study.

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Case Study

How Center for Primary Care Improved their HCC Coding Without Hiring Additional Staff Center for Primary Care chose the HCC Coding Engine to streamline their risk adjustment coding workflow and improve their RAF score accuracy through automation. Learn how the software helped them uncover $6M in RAF value and work more efficiently without hiring additional coders.

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Case Study

How Pacific Cataract and Laser Institute Achieved Their Lowest-Ever Rejection Rates Pacific Cataract and Laser Institute (PCLI) was already operating at a high standard when it came to their clean claim rate—but they knew they could do better. Find out how they achieved a 75% automation rate and their lowest-ever rejection rates with RCxRules.

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Sue Gillies Vice President of Revenue Cycle Management Crystal Run Healthcare

“The ability to transfer ten members to specifically work on the appeals from insurance companies was a true win-win for us. The move definitely benefited our A/R and outstanding A/R functions.”

Christi Garriott Senior Vice President of Business Intelligence and Revenue Peak Vista Community Health Centers

“Now out of 3,000 tasks a day, we probably have to manually review about 100. Everything else automatically posts. Clean claims go out the first time without the need to review them.”

Christi Garriott Senior Vice President of Business Intelligence and Revenue Peak Vista Community Health Centers

“During implementation, we achieved a high success rate because of the support from the RCxRules team. They were responsive to our unique needs and performed some fast development changes that made the rules engine a super-useful solution.”

Case Study

How U.S. Dermatology Partners Achieved Their Highest Clean Claim Rates Despite Staffing Challenges U.S. Dermatology Partners implemented the RCxRules Revenue Cycle Engine to automate the charge import and review process. The team was able to overcome their staffing challenges by reallocating 10 full-time employees–while simultaneously achieving their highest ever clean claim rate.

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Aaron Houston CEO Family Health Services

"I put the RCxRules Revenue Cycle Rules in a different category. It is one of only a few products we have bought where the value exceeded what the salesperson promised. It is usually the other way around where the salesperson promises a lot and the product struggles to live up to the expectations."

Chris Cousins Vice President, Managed Care & Ancillary Services Springfield Clinic

“Based on our existing relationship with RCxRules, we knew they were the right choice to help us. We had three specific requirements for an HCC coding solution, and RCxRules was able to accommodate them all. We look forward to continuing this successful partnership.”

Stephanie McEuen Business Office Director Millennium Physicians

"The automation and customization the RCxRules Revenue Cycle Rules software has brought to our charge review process has been a complete game changer. In combination with its ease of use and great customer support, we're able to get payer-ready claims out the door faster and cleaner than ever before. We're very happy with our decision to partner with RCxRules."

Bill Oliver VP, Medical Group Billing Prospect Physician Enterprise

“By helping us become proactive in our approach, RCxRules has significantly streamlined our billing and coding process while decreasing avoidable denials and accelerating cash. What was once manual and time-consuming has become largely automated. We were able to leverage the expertise we already had in house to create a solution that helps our staff be more productive and focus on more meaningful billing related tasks.”

Case Study

How Crozer Health Improved Efficiency and Reduced Denials Crozer Health implemented RCxRules to be the conduit where all charges were interfaced or manually posted. The use of a single platform introduced a consistent and scalable charge review process across all clinical systems.

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Pat Conover Managing Director, Information Application Services Texas Tech University Health Sciences Center

“We’re very happy with our decision to partner with RCxRules. Not only have they delivered superior claim scrubbing capabilities compared to our legacy scrubber, but they have also demonstrated exceptional customer service and commitment to our success. TTUHSC looks forward to a long and productive relationship with RCxRules.”

Terry Keeling Vice President of Information Technology University Hospitals

"The RCxRules software has automated several manual processes such as reducing provider's time in the EHR and charge posting errors. The ease of customizing the software and the high-touch implementation led to a smooth go-live and set the stage for continued success."

Case Study

Crystal Run Healthcare Strengthens Bottom Line The more eyes for charge review, the better the results, so they thought—until they explored RCxRules Revenue Cycle Rules Software. A new chapter in raising efficiency and implementing cost savings had begun.

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Kimberly Dillard Director of Business Services PIH Health Physicians

"We are very grateful to have RCxRules. The software has ensured our financial stability, even during a pandemic."

Case Study

Quick ROI for FQHC Peak Vista Community Health Centers, an FQHC, turned to RCxRules to improve billing efficiency. Learn how the Revenue Cycle Rules software lead to a quick ROI.

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Christi Garriott Senior Vice President of Business Intelligence and Revenue Peak Vista Community Health Centers

“RCxRules has allowed us to focus on quality vs quantity, to be able to realign staff to places where we could really use some help, but had not yet been able to afford to move staff.”

Christi Garriott Senior Vice President of Business Intelligence and Revenue Peak Vista Community Health Centers

“We were immediately able to divert staff from reviewing charges to other things. We focused our staff in a more effective way, a big part of that was customer service. For example, we used to have patients leave voicemails regarding their bills. With freed up staff, we’re now able to support a live phone answering service. We also have an FTE supporting one of our grant funded programs which helps our community by increasing the number of seniors getting access to dental care.”

Chad Barringer Director of Revenue Cycle Management OrthoCarolina

“When I think about RCxRules, I think about them more as a business partner rather than just a vendor, because they’ve really listened to us—what our business needs are and helped to configure our system to meet those needs.”

Shannon Hubler COO The South Bend Clinic

"Within 30 days we were up and running. On day one we saw immediate value by capturing missed RAF revenue. The increase in revenue, required zero process changes to our clinical operations and optimized our coder’s productivity. Any value-based care organization should use RCxRules, it pays for itself ten-fold."

Case Study

South Bend Clinic Improves RAF Score Accuracy and HCC Coder Efficiency SBC hired a single HCC coder to concurrently review value-based encounters. They leveraged their coder and the RCxRules software to improve RAF scores by 34% through increased HCC capture/re-capture rates.

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Kelly Macken-Marble CEO The South Bend Clinic

"In a single week we saw an additional $62.5K+ in otherwise missing RAF value by using the RCxRules HCC Coding Software. With RCxRules, we were easily able to scale up with value-based contracts. The value of RCxRules software is unprecedented, in fact, it’s a necessity for any organization with risk-based contracts."

Case Study

How Arizona Community Physicians expanded its HCC coding process from 12 sites to 53—with higher accuracy and fewer FTEs Arizona Community Physicians’ HCC coding process required 3 FTEs for only 12 sites. Now, with targeted HCC coding rules implemented using RCxRules software and backed by a concurrent coder review process, 2 FTEs handle all 53 of its sites.

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Video

Video Testimonial: North American Partners in Anesthesia Listen to Jasmine Bertsch, Applications Analyst from NAPA, share how RCxRules helped centralize NAPA’s unique payer, provider, specialty and other complex billing requirements to automate revenue cycle operations for less denials, faster payment and fuller reimbursement.

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Jasmine Bertsch Applications Analyst North American Partners in Anesthesia (NAPA)

“Implementing the RCxRules solution has allowed us to address challenges when billing from a variety of clinical documents throughout our organization. The solution has improved our ability to detect and correct claim defects in an automated fashion in order to comply with payer specific claim submission rules and requirements. The improved reporting transparency in claim errors has also allowed us to launch initiatives to re-educate staff and modify business practices to improve collections. RCxRules has simplified the arduous task of managing the voluminous payer specific medical policies, reimbursement policies and claim submission requirements we must comply within multiple states. RCxRules is also very user-friendly and does not require someone with the skillset of a programmer to create rules. It’s seamless and the verbiage used for rule writing is pretty intuitive. Overall, the ease of use has been a positive experience and has generated positive efficiencies within our business operations.”

Tonya Weston Coding and Insurance Manager Mankato Clinic

"What we thought we could do with RCxRules early on has really morphed into so much more than what we expected. We’re constantly thinking of new rules that can streamline our process."

Case Study

MA Hospital Increases HCC Recapture for More Accurate Risk Adjustment Learn how one organization increased their HCC recapture rate by 15% in 60 days, uncovering $750,000 in HCC recapture opportunities.

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Jackie Bowlds Billing and Collections Manager South Bend

“The RCxRules software and the knowledgeable support team brought our RCM department to the next level. We increased our output by 31,000 encounters per year without needing additional staff. We couldn’t be happier, especially since morale has increased, too!”

Brian Hall President Physicians Resources, LTD (PRL)

“With RCxRules, we have dramatically reduced denials and improved staff efficiency. This helps us continue to improve the level of service we provide to our physician customers, which is essential given today’s competition. I don’t see how we could produce these results without RCxRules.”

Chris Hughes Director, Central Business Operations Baptist Primary Care, Inc.

“RCxRules has changed the way we work for the better, allowing us to expand our business without increasing the size of our team. We can take on more with less. Our dedicated RCxRules implementation and support team have been outstanding, working with us every step of the way—responsive, competent, and flexible.”

Kimberly Clifton Director of ACO Operations Arizona Community Physicians

“The automation RCxRules brought to our HCC coding process led to a dramatic productivity hike in our organization and is a key factor in our success with MSSP. The technology is extremely user-friendly and the RCxRules team is flexible and responsive."

Video