At Valiant Lifecare, we measure success by the impact we have on our clients' bottom lines. Here are real-world examples of how our RCM, coding, and risk adjustment services drive measurable results.
85-Provider Multi-Specialty Group, Midwest
Challenge: A multi-specialty physician group with 85 providers was facing a 14% claim denial rate, 68-day average accounts receivable days, and an understaffed billing department. Revenue was leaking through the cracks.
Solution: Valiant Lifecare assumed end-to-end RCM responsibility: coding, billing, denial management, and A/R follow-up. We implemented structured denial management protocols, initiated concurrent coding reviews, and deployed a dedicated account team.
Large Regional Medicare Advantage Health Plan
Challenge: A large regional Medicare Advantage health plan identified significant HCC coding gaps through internal retrospective review. RAF scores were below expected benchmarks for their member population.
Solution: Valiant Lifecare deployed a full retrospective risk review team to audit member encounters and identify HCC capture opportunities. We then implemented a concurrent review program and ongoing prospective review.
Commercial Health Plan, Southeast United States
Challenge: A regional commercial health plan was underperforming on key HEDIS measures, directly impacting quality bonus payments and plan enrollment. Internal capacity for medical record retrieval and hybrid abstraction was limited.
Solution: Valiant Lifecare deployed a dedicated HEDIS abstraction team to manage end-to-end medical record retrieval, hybrid review abstraction, and supplemental data submission covering 40+ HEDIS measures.