How Full RCM Services Increased Collections by 32% for a Gastroenterology Infusion Practice

RCM Services covers the full revenue cycle from scheduling through payment. This includes authorization, coding, claims, AR follow up, and collections. Many practices fix only one stage and expect full results. That approach rarely moves total collections in a meaningful way. A gap in one stage often creates new problems in another. Full RCM Services means every stage is connected and working together. This connected approach is what separates lasting results from temporary fixes.

At Infusion Billing Services, we recently completed a full engagement for a client. Their gastroenterology practice administered high cost biologic infusions regularly. This case study explains how complete RCM Services increased collections by 32 percent. It also shows why partial fixes had failed to solve the problem before.

Client Snapshot

Our client was a gastroenterology practice that specialized in biologic infusion therapy. They had two clinics, and treated approximately 400 patients every month. Their infusion service revenue was mostly of biologic drugs. Commercial insurance, Medicare, and Medicare Advantage were a part of the payer mix. Nearly half of the volume was from commercial payers. We reviewed twelve months of financial data before starting this engagement. The baseline collection rate stood at just 68 percent of billed charges. Average AR days extended past 58 days at the start of review. No single team had visibility across the entire revenue cycle. This gap in oversight was the core problem full RCM Services addressed.

RCM Gap 1: Front End Scheduling and Prior Authorization for Biologics

Prior authorizations for biologic infusions were often requested too late. Some visits were scheduled before authorization status was even confirmed. Tracking across different biologic drugs was inconsistent and often incomplete. This gap caused delayed visits and denied claims after service.

Problem:

• Authorization requests were submitted close to the visit date
• Biologic authorization tracking varied across drug therapies
• Visits proceeded without confirmed authorization in some cases

Fix:

• Built a front end authorization workflow tied to scheduling
• Required confirmed authorization before booking a biologic visit
• Tracked authorization status separately for each biologic drug

This fix closed the earliest and most preventable gap in RCM Services. It set the tone for every other stage that followed.

RCM Gap 2: Mid Cycle Coding and Charge Capture Gaps

Complex infusion visits created frequent charge capture inconsistencies over time. Documented drug quantities did not always match what was billed. Administration time was sometimes recorded differently than the actual service given. These mismatches created claims that failed under closer payer review, a clear gap for RCM Services to address.

Problem:

• Billed drug quantities did not match clinical documentation on file
• Administration time entries were inconsistent across visits
• Charge capture errors were caught only after claim submission

Fix:

• Standardized coding specific to biologic infusion protocols used
• Reconciled charges against documentation before claims were released
• Reviewed complex visits for accuracy before final submission

Charge accuracy became a key mid-cycle pillar within full RCM Services.

RCM Gap 3: Back End AR Follow Up and Aging Claims

A substantial amount of revenue in claims which were over 60 days was not being collected. Claims were not listed in order of dollar value or urgency. Some claims aged past 90 days without any follow up occurring. This backlog represented real revenue the practice had already earned, and it became a priority focus under RCM Services.

Problem:

• Claims aging past 60 days lacked consistent, timely follow up
• Aging claims were not prioritized based on total dollar value
• Some claims reached 90 days without any staff review

Fix:

• Introduced structured AR aging reports reviewed on a schedule
• Prioritized follow up based on claim age and dollar value
• Assigned dedicated staff ownership for high value aging claims

Structured AR follow up recovered revenue that had been effectively abandoned. This became one of the fastest wins within the broader RCM Services engagement.

RCM Gap 4: Denial Resolution and Appeals Management

Claims for biologic infusions were stacking up for denials with no resolution. There was not a specific or formal procedure for classification and prioritization of these denials. Appeals were filed in an irregular fashion and numerous deadlines were missed. This left recoverable revenue permanently written off, a gap RCM Services was built to close.

Problem:

• Denials had no consistent categorization or prioritization process
• Appeal deadlines were missed due to lack of ownership
• Denied claims sat unresolved for extended periods of time

Fix:

• Built a denial resolution workflow specific to infusion claims
• Assigned clear ownership and deadlines for every denied claim
• Tracked appeal outcomes to identify recurring denial patterns

Consistent denial resolution turned lost revenue into a recoverable, tracked asset.

RCM Gap 5: Patient Financial Responsibility and Collections

Patient responsibility balances for infusion therapy were often quite high. These balances were not communicated clearly before treatment began. Follow up on outstanding patient balances was inconsistent across the practice. This left a meaningful share of earned revenue uncollected, another area RCM Services needed to address directly.

Problem:

• Patient cost estimates were not provided before treatment started
• Outstanding balances lacked a consistent follow up process
• Collection efforts varied depending on which staff handled it

Fix:

• Implemented upfront patient cost estimates before biologic infusions
• Built a structured follow up process for outstanding balances
• Standardized patient communication across every stage of collection

Improving patient collections closed a gap that pure claims work could not.

RCM Gap 6: Reporting, Analytics and Continuous Improvement

The practice had no clear visibility into revenue cycle performance. Leadership could not identify which stage was losing the most money. Without this visibility, problems repeated month after month unnoticed. Full RCM Services requires ongoing measurement, not a one time fix, and reporting made that measurement possible.

Problem:

• No consolidated reporting existed across the revenue cycle stages
• Leadership could not identify which stage caused the most loss
• Recurring issues went unnoticed without regular trend review

Fix:

• Built monthly performance reporting across the entire revenue cycle
• Tracked collections, denials, and AR trends in one place
• Gave leadership visibility to guide ongoing decisions and priorities

This reporting layer turned RCM Services into a continuously improving system.

Financial Recovery Results

The table below reflects the full impact across every stage reviewed. These results show what connected, full cycle RCM Services can deliver.

These numbers reflect improvement across every connected stage of the cycle. No single fix could have produced this level of total impact. This is the core value that full RCM Services delivers over time. It also confirms the results reflect a system, not a single change.

Key Takeaways

These lessons apply broadly to any practice evaluating full RCM Services.

• Full RCM Services connects every stage, not just isolated fixes
• Front end authorization prevents denials before service is even given
• Charge capture accuracy protects revenue at the mid cycle stage
• AR follow up and denial resolution recover revenue already earned
• Reporting gives leadership visibility to guide continuous improvement efforts

Conclusion

This case shows that partial fixes rarely move total collections meaningfully. Full RCM Services connects scheduling, coding, AR, denials, and collections together. Each stage reinforces the others, creating a complete and lasting system. The result was a 32 percent increase in total collections. It also gave leadership real visibility into how RCM Services performs. If your practice needs a complete revenue cycle solution, we can help. Infusion Billing Services builds full RCM Services tailored to infusion practices. A connected RCM Services system protects and grows revenue at every stage.

Contact Infusion Billing Services today for a complete revenue cycle assessment. Start building a system that captures every dollar you have earned.