30% More Reimbursements and 21 Days Faster Payments With Outsourced, AI-Driven RCM

Outsourcing and AI in Revenue Cycle Management: A Practical Playbook for Leaders

Hiring seasoned RCM staff is getting harder. At the same time, payer rules keep shifting. That mix is why many practices are outsourcing their revenue cycle and adding AI to the process.

One example: Orlando Heart & Vascular Institute, an independent practice with six providers and 40 employees, chose eClinicalWorks for RCM. After the switch, reimbursements increased by 30%, and payments arrived an average of 21 days faster.

What drove the results

• Same-day billing: A larger billing team pushed claims out the day of the visit.
• AI before submission: Errors were caught early, cutting denials.
• Data-informed coding support: The system flagged cases where high-cost codes were often rejected and suggested downcoding when documentation didn't justify the higher code.
• Focus on growth: With cash flow stabilized, the practice stayed independent and expanded around a new CT machine.

Management checklist

• Baseline the numbers: Net collection rate, days in A/R, denial rate, clean claim rate, first-pass yield, and lag days from encounter to submission.
• Set clear SLAs: Same-day claim submission, denial turnaround time, appeal cadence, and coding response times.
• AI guardrails: Require pre-claim edits and payer-specific rules with clear override logic and compliance review.
• Tight feedback loops: Weekly dashboards, payer trend reviews, root-cause analysis for denials, and documented fixes.
• Smart staffing: Keep an internal RCM lead for oversight; outsource high-volume, repeatable work. Define escalation paths.
• Governance: Quarterly audits, coding policy updates, payer rule tracking, and verified data security practices.
• Outcome targets: 15-30% lift in reimbursements and 2-4 weeks faster payments are realistic when the fundamentals are in place.

Questions to ask an RCM partner

• What is your clean claim rate and first-pass acceptance by payer?
• How does your AI prevent common errors before submission?
• Can you submit more than 90% of claims the same day?
• What reporting cadence and transparency will we get?
• How do you handle downcoding recommendations to align with documentation and medical necessity?

Case details and resources

Practice: Orlando Heart & Vascular Institute

RCM services: eClinicalWorks

Next steps for managers

• Run a quick audit of the last 90 days: denial categories, average lag days, and payer-specific issues.
• Pilot AI-driven pre-claim edits on a high-volume specialty and compare first-pass yield and payment timing.
• Reinvest early gains in growth capacity (imaging, diagnostics, or access) to compound the cash flow impact.

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