Front-end control
- Zero-day credentialing and enrollment.
- Automated prior authorization and eligibility verification.
- Dual-component (26/TC) coding optimization.
- AI and automation for pre-submission claim validation.
Diagnostic Radiology·Published September 2026
Turning payer policy lag into a 97.2% clean claim rate
A 24-location diagnostic radiology group in Michigan was waiting on commercial payers to catch up with new procedures and CPT codes. MBS moved control to the front end, escalated directly with payers, and built evidence-based clinical appeals.
- Clean claim rate
- 97.2%
- A/R days reduction
- 52%
- Revenue collected
- $725.8K → $5.23M
- Time to core framework
- 90–120 days
Above HFMA's 95% benchmark
2023 to 2025
Specialty
Diagnostic Radiology
Practice size
~9.5K patients served a year
Locations
24 locations across Michigan
Payer mix
50% commercial, 40% Medicare, 10% Medicaid
Client tenure with MBS
3.5 years
Engagement objective
What the client needed
- Strengthen the revenue cycle by reducing payer-related delays.
- Improve claim processing for newly introduced procedures and codes.
Starting position
The challenges
- Commercial payer policy lag delayed reimbursement for new radiology procedures.
- Medical necessity denials increased because commercial payer policies were outdated.
- Higher A/R days caused by manual documentation and paper-based appeals.
- Electronic claim processing failed for newly introduced CPT codes.
Solutions
What MBS put in place
Payer escalation and appeals
- Direct payer escalation for delayed claims.
- Evidence-based clinical appeal management replacing paper-based appeals.
- End-to-end revenue cycle optimization across the 24 locations.
Reporting, tools, and training
- Front-end operational dashboards, plus coding and profitability analytics.
- Denial and payer performance reporting alongside A/R and financial health dashboards.
- Multi-payer direct deposits, digital patient intake, and patient-pay portals.
- Staff training delivered across the front-end and billing teams.
Impact
What changed
- A clean claim rate averaging 97.2%, above HFMA's 95% industry benchmark.
- A 52% reduction in A/R days.
- Revenue collected grew from $725,802 in 2023 to $5,227,079 in 2025, with $3,709,238 collected in the first half of 2026.
- Increased physician referrals, a better patient financial experience, and reduced administrative burden.
Recovery
Annual revenue collection
2023 to mid-2026
| Period | Revenue collected |
|---|---|
| 2023 | $725,802 |
| 2024 | $3,213,895 |
| 2025 | $5,227,079 |
| 2026 (Jan–Jun) | $3,709,238 |
Time to first results
The core framework was implemented within 90 to 120 days, with staff training running alongside it.
Why it worked
The operating model behind the result
- Strategic alignment on front-end control.
- A proactive rather than reactive regulatory stance.
- Specialized expertise in radiology coding realities, including dual-component billing.
- A shared commitment to patient-centric financial workflows.
- Data-driven transparency and accountability.
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