Case Study
Case Studies
Client Profile
A multi-specialty outpatient clinic based in Texas with 12 providers, averaging 4,500 claims per month.
Challenge
The clinic faced rising claim denials and a growing backlog of unpaid accounts. Key issues included:
- High denial rate (18%) due to coding and eligibility issues
- Manual A/R follow-ups taking weeks
- Lack of predictive insights on payer trends
- Inefficient workflow leading to payment delays
Solution
Yaqeen RCM implemented its AI-enhanced RCM suite, integrating predictive analytics and workflow automation across key touchpoints:
AI Tools Deployed:
- Predictive Denial Analytics: Flagged high-risk claims before submission
- NLP-Based Coding Review: Identified missing modifiers and improved CPT/ICD matching
- Smart A/R Prioritization Engine: Ranked follow-ups based on payer behavior and recovery likelihood
- Automated Eligibility Checker: Verified patient coverage in real-time using AI-powered rulesets
Results
- Denial Rate Reduced: from 18% → 6.2%
- A/R Days Improved: from 42 → 26 days
- Collections Increased: Net collections rose by 19%
- Staff Efficiency: Reduced manual tasks by 35%, freeing time for patient support
- Executive Insights: Dashboard provided real-time claim performance and payer analytics
