Real results from healthcare providers who transformed their revenue cycle with MedLegacyRcm
Medicare Advantage Health Plan, Arizona
A Medicare Advantage health plan in Arizona was experiencing significant revenue leakage due to incomplete HCC (Hierarchical Condition Category) coding. Their RAF (Risk Adjustment Factor) scores were below industry benchmarks, resulting in lower capitation payments. The plan was missing chronic conditions that should have been documented and coded, leading to an estimated $800K+ in lost annual revenue.
MedLegacyRcm deployed a specialized HCC coding team with deep expertise in risk adjustment coding. We conducted comprehensive chart reviews, identified missed chronic conditions, and implemented a systematic approach to HCC capture. Our team worked closely with providers to improve documentation and ensure accurate RAF score optimization while maintaining full compliance with CMS guidelines.
Annual Revenue Increase
From improved RAF scores
RAF Score Improvement
Average per member
RADV Audit Ready
Zero audit findings
"MedLegacyRcm's HCC coding expertise transformed our risk adjustment program. We recovered $850K in the first year alone through improved RAF scores. Their team's attention to detail and compliance focus gave us confidence that we're maximizing revenue while staying audit-ready. The ROI has been exceptional."
— Patricia Williams, VP of Risk Adjustment
Emergency Department, Large Hospital System, Illinois
A large hospital system's emergency department in Illinois was experiencing significant revenue loss due to undercoding of E/M levels. ED visits were consistently coded at lower levels (99281-99283) when documentation supported higher complexity levels (99284-99285). Additionally, the transition to 2021 E/M guidelines created confusion, leading to inconsistent coding practices. The department was losing an estimated $2.2M annually in undercoded visits.
MedLegacyRcm assigned certified ED coders with specialized expertise in emergency department coding and the 2021 E/M guidelines. We conducted a comprehensive audit of 6 months of ED visits, identified undercoded cases, and implemented a systematic review process. Our team provided real-time coding support and education to ensure accurate level assignment based on medical decision making (MDM) complexity.
Revenue Recovery
$2.2M annual increase
Higher-Level Visits
Accurately coded
Audit Risk
Compliant coding
"MedLegacyRcm's ED coding team identified significant revenue opportunities we didn't know existed. They recovered $2.2M in the first year by accurately coding our ED visits. Their expertise with the 2021 E/M guidelines ensured we're maximizing revenue while maintaining full compliance. The impact on our bottom line has been substantial."
— Dr. Michael Thompson, ED Medical Director
Large Orthopedic Surgery Group, New York
A large orthopedic surgery group in New York was experiencing significant revenue loss due to surgical coding errors and missed procedures. Complex surgeries were being undercoded, modifiers were incorrectly applied, and bundled procedures were not being properly unbundled when appropriate. The practice was also facing NCCI edit violations and payer denials. Estimated annual revenue loss exceeded $1.5M.
MedLegacyRcm deployed certified orthopedic surgery coders with deep expertise in musculoskeletal procedure coding, modifier application, and NCCI bundling rules. We conducted a comprehensive audit of surgical cases, identified coding errors and missed opportunities, and implemented a rigorous review process. Our team provided real-time coding support, ensured proper modifier usage, and optimized unbundling opportunities while maintaining full compliance.
Annual Revenue Recovery
From coding optimization
Denial Reduction
Surgical claim denials
NCCI Compliant
Zero edit violations
"MedLegacyRcm's surgery coding expertise was a game-changer for our practice. They recovered $1.4M in the first year by identifying missed procedures, correcting modifier errors, and optimizing our coding. Their understanding of NCCI rules and bundling guidelines ensured we're maximizing revenue while staying compliant. The reduction in denials alone has saved us countless hours of administrative work."
— Dr. Lisa Rodriguez, Practice Administrator
25-Physician Cardiology Group, Texas
A prominent 25-physician cardiology practice in Texas was experiencing significant revenue cycle challenges. Their denial rate had climbed to 32%, payment cycles averaged 85 days, and coding errors were leading to audit concerns. The practice was losing approximately $150,000 monthly in denied or delayed claims.
MedLegacyRcm implemented a comprehensive RCM solution including AAPC-certified cardiology coders, real-time claim scrubbing, and aggressive A/R follow-up. Our 24/7 operations ensured continuous monitoring and rapid response to denials.
Denial Rate Reduction
From 32% to 17.6%
Faster Payment
85 days → 28 days
Monthly Revenue Increase
Recovered revenue
"MedLegacyRcm transformed our revenue cycle completely. The 24/7 operations mean we never miss a beat, and the cost savings allowed us to invest in new cardiac imaging equipment. Our denial rate dropped from 32% to under 18% in just three months."
— Dr. Sarah Mitchell, Practice Administrator
Large Multi-Specialty Group, California
A large multi-specialty group in California had accumulated over $3.5 million in aged receivables (90+ days). Previous collection efforts had failed, and the practice had written off most accounts as uncollectible. The CFO was seeking a solution to recover at least a portion of these funds.
MedLegacyRcm deployed a specialized A/R recovery team with expertise in aged account collection. Our team conducted comprehensive account analysis, implemented professional patient communication strategies, and pursued aggressive payer follow-up with systematic appeals processes.
Recovery Rate
$2.1M of $3.5M
Timeframe
Full recovery period
ROI
On investment
"We had written off these accounts as lost. MedLegacyRcm's A/R recovery team recovered $2.1 million we never expected to see. Their professional approach and persistence made all the difference. This recovery directly funded our expansion into a new specialty."
— Maria Lopez, CFO
Orthopedic Surgery Center, Florida
An orthopedic surgery center in Florida was experiencing coding errors and claim rejections due to complex procedure coding requirements. Their clean claim rate was only 78%, leading to delayed payments and increased administrative burden. The practice was also concerned about potential audit exposure.
MedLegacyRcm assigned AAPC-certified orthopedic coders with specialized expertise in musculoskeletal procedures. We implemented a rigorous quality assurance process with secondary review, automated validation, and documentation verification for every claim.
Clean Claim Rate
Up from 78%
Coding Error Reduction
Near-zero errors
Audit Ready
Zero audit findings
"The precision of MedLegacyRcm's coding team is exceptional. We went from constant coding errors and claim rejections to a 98.5% clean claim rate. When we had a CMS audit, every single claim was perfect. That's the kind of accuracy that gives us confidence."
— Dr. Robert Chen, Medical Director
12-Location Primary Care Network, North Carolina
A 12-location primary care network in North Carolina was managing RCM in-house across multiple locations with inconsistent results. High overhead costs, staffing challenges, and varying performance across locations were impacting profitability. They needed a unified, cost-effective solution.
MedLegacyRcm implemented a complete end-to-end RCM solution across all 12 locations. We integrated with their existing EMR system, standardized processes, and provided unified reporting. Our 24/7 operations ensured consistent performance regardless of location.
Cost Reduction
vs. in-house RCM
Clean Claim Rate
Consistent across all locations
Reporting
Single dashboard for all locations
"Consolidating our RCM with MedLegacyRcm was the best decision we made. We saved 35% on costs, improved consistency across all locations, and now have unified reporting. Our staff can focus on patient care instead of billing headaches."
— James Anderson, Network Administrator
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