Case studies – Clientele RCM

CLIENT RESULTS

Real Practices. Real Numbers. Real Revenue Recovery.

Every case study below reflects an actual client engagement, documenting denial patterns, specific interventions, and measurable outcomes. No named practices per client preference. Every number is real.

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Active Clientele RCM client accounts only

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Active states: MI, IL, FL, NY, KY, NJ, DC

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Showing 4 of 12 Case Studies & Previews

ORTHOPEDICS

DENIAL MANAGEMENT

MICHIGAN

MULTI-SPECIALTY ORTHOPEDIC CLINIC · MICHIGAN · 6 PROVIDERS

THE PROBLEM

A six-provider orthopedic surgery group in Michigan was experiencing a denial rate significantly above industry average — concentrated in two categories: global period billing disputes on post- operative E/M visits, and bilateral procedure modifier mismatches on knee and shoulder arthroscopy claims. The practice had been with the same billing company for four years. The billing company had no orthopedic-specific protocol for global period tracking and was applying Modifier -50 to bilateral procedures for all payers — including commercial payers that require – RT/-LT with separate line billing.

THE APPROACH

Clientele conducted a 90-day denial audit before onboarding — billing to their PT and OT service lines six months prior to engaging Clientele. Two protocols were built before the first claim was submitted: 1) Global period tracking protocol — every surgical claim tracked against its global period; E/M visits within the global period flagged for modifier review before submission (-24, -25, -57, or -79 applied based on clinical documentation). 2) Bilateral modifier mapping — payer- by-payer modifier rule documented for all major payers.

KEY PERFORMANCE METRICS

90-Day Audit Interval

METRIC

BEFORE

AFTER 90 DAYS

Clean claim rate

81%

99%

Global period denial rate

18% of surgical claims

Under 3%

Average A/R days

47 days

31 days

Back-end denial appeal success

No systematic process

78% appeal overturn rate

“Global period disputes were a monthly problem we just accepted as normal. Clientele showed us in the first audit
that 80% of them were preventable, wrong modifiers, not wrong billing. Having a protocol made it stop.”

Revenue Cycle Manager Multi-Specialty Orthopedic Clinic · Michigan

⚠️ COMING SOON

ANESTHESIA · FLORIDA · CRNA BILLING

Expansion Case: Anesthesia Compliance & A/R Recovery

This in-depth case study is currently being assembled with audited client metrics and will be released pre-launch.

⚠️ COMING SOON

MULTI-SPECIALTY · NEW YORK · ONBOARDING

Expansion Case: Multi-Specialty Compliance & A/R Recovery

This in-depth case study is currently being assembled with audited client metrics and will be released pre-launch.

⚠️ COMING SOON

CHIROPRACTIC · ILLINOIS · CLAIMS

Expansion Case: Rehab Compliance & A/R Recovery

This in-depth case study is currently being assembled with audited client metrics and will be released pre-launch.

RISK-FREE VERIFICATION

Every Case Study Starts the Same Way With a Free Audit

Before we take ownership of a single claim, we conduct a deep-dive audit of your current billing workflows, denial patterns, and A/R aging. That audit is free. It’s also where most practices discover what’s actually costing them revenue.

Free 90-day denial audit

We review your historic denial codes, CPT patterns, and payer performance logs to identify systemic leakage.

Revenue gap report

You receive a documented breakdown of exactly where revenue is being lost, why claims are being rejected, and their financial recovery potential.

Targeted proposal

If the numbers support an engagement, we propose a tailored compliance scope. If they don’t support it, we will tell you that too.

FEEDBACK FROM CLIENT TEAMS

“Denials dropped significantly within the first fewweeks. The visibility into our claims and the team’s follow-up discipline made an immediate impact something we hadn’t experienced with our previous billing company.”

Revenue Cycle Manager

Multi-Specialty Orthopedics Clinic · Michigan

“Our clean-claim performance improved, A/R became predictable, and for the first time we had reporting that helped us act not just review numbers after the fact.”

Director of Operations

Interventional Pain Management Center · Florida

“We thought RTM/RPM billing was set upcorrectly because our device vendor told us it
was. Clientele’s audit showed us four different compliance problems, some were creating
overpayment exposure, not just denials. They fixed it systematically, not claim by claim.”

Director of Rehabilitation Services

Multi-Specialty Physical Therapy · New Jersey

Want Results Like These for Your Practice?

Start with a free RCM audit. No commitment, no obligation just a clear picture
of what revenue your practice is leaving on the table and how to get it back.

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