Telehealth RCM Case Study: Clean Claims 84.1% to 97.8%

Telehealth RCM Case Study: Clean Claims From 84.1% to 97.8%

Primary outcome (Actigy BPO-reported)

Actigy BPO raised the clean claim rate (CCR) from 84.1% to 97.8%. The team also cut days sales outstanding (DSO) by 15 days and improved cash flow. The anonymized telehealth provider kept clinical, coding and banking authority; the delivery team worked inside approved systems.

Results come from anonymized client engagements, are reported by Actigy BPO and are not independently audited. Results depend on scope.

Engagement boundary: this telehealth case separates administrative billing work from clinical documentation, credentialing, and banking authority retained by the client.

By Actigy BPO Editorial Team Published June 14, 2026 · Last updated October 25, 2026

97.8%

Clean Claim Rate

31%

Reduction in DSO

Scoped

Access and audit logging

Based on a real engagement. The client is anonymized and some operational details are generalized to protect confidentiality; the metrics reflect the engagement as delivered.

Engagement summary

The billing team ran revenue cycle management (RCM) for an anonymized multi-state telehealth and clinical provider network.

Delivery model: Managed operations team
Client Segment: Multi-State Telehealth & Clinical Provider Networks
Core Systems Intersected: Epic Systems, Kareo, Change Healthcare Clearinghouse
Scope delivered: Eligibility, coding support, claim submission, denials and receivables follow-up

The challenge: an 84.1% clean claim rate and slow collections

Technical insurance claim denials caused mounting revenue leakage at a scaling digital health platform. The internal billing team could not keep pace with changing payer policies. International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT) codes were misapplied, and prior authorizations went missing. A growing backlog of aged accounts receivable (AR) threatened the operating runway.

Workflow and monthly volume

The billing team managed the front-end and back-end medical billing lifecycle from a delivery team in Romania.

Process volume

The team handled these volumes:

Claims submitted: 18,000+ medical claims processed per month.
Denial appeals: 2,200+ rejected claims triaged and resubmitted monthly.
Prior authorizations: 900+ high-complexity verification requests per week.

Team

Dedicated delivery team: 1 medical billing delivery manager, 2 medical coders and 12 RCM specialists.

Workflow

The team ran four workflow stages:

Demographic verification: Validating patient insurance eligibility before clinical encounters.
Charge capture and coding: Translating clinical notes into compliant ICD-10, CPT and Healthcare Common Procedure Coding System (HCPCS) modifiers.
Clearinghouse scrubbing: Managing front-end edits and fixing data structure errors before payer submission.
Denial management: Analyzing electronic remittance advices (ERAs), correcting coordination of benefits and drafting targeted appeals.

Quality assurance model

The QA team operated a double-blind coding audit matrix. Its proprietary rules engine flagged claims with high-risk modifier combinations. Medical coders on the team validated those claims. Continuous cross-checks tested claims against Medicare, Medicaid and major commercial payer guidelines.

Tools

Client stack: Epic, Kareo, Change Healthcare, Optum360.
Proprietary workflow tools: Actigy BPO SmartCode (automated claim scrubbing ruleset engine).

What stayed with the client

The client kept exclusive ownership of clinical definitions, documentation policies, provider credentialing and direct banking deposits. The billing team operated only as an administrative partner. The team never altered clinical documentation. It routed any charting gaps back to the client's medical staff through structured queries.

Results

The figures below describe this anonymized engagement, not a forecast for another scope.

Revenue cycle results: client baseline and engagement outcome (Actigy BPO-reported)
Operational Metric	Legacy Client State	Engagement outcome	Change from baseline
Clean Claim Rate (CCR)	84.1%	97.8%	13.7 percentage points higher
Days Sales Outstanding	48 days	33 days	15 days lower (31.25%)
Prior Auth Turnaround	72 hours	14 hours	58 hours shorter (80.6%)

To define a comparable pilot, use Actigy BPO's medical billing process map and handoff checklist. Review the denial statistics and rework model and prior authorization workload model separately: their published populations and illustrative costs are not measurements of this engagement.

Additional before-and-after key performance indicators (KPIs) (Actigy BPO-reported):

Denial rate: The billing team cut the denial rate from 15.9% to a sustained 2.2%.
Aged AR (over 90 days): The collections team reduced aged AR from 24% of total portfolio value to 4.5%.
Daily production yield: The billing team raised claim submission from 45 to 110 clean claims per agent per day.

If you are building a provider shortlist, compare medical billing companies using the same workflow and approval requirements.

How the pilot worked

The pilot team proved clean-claim and denial-handling quality on a controlled pilot before it scaled the full revenue cycle.

Timeline to pilot

14 days: The team prepared scoped access and launched a 500-claim test batch in the approved systems.

Timeline to scale

35 days: The team took over all multi-state billing, coding and back-end RCM operations.

Services used

Review the current telehealth billing services scope separately from these engagement results.

This engagement used medical billing outsourcing for claims, denials and AR, and medical coding outsourcing for ICD-10, CPT and HCPCS review.

Actigy BPO describes the current scope of denial management services. The telehealth case does not establish results for another setting.

Engagement outcomes (Actigy BPO-reported)

This case describes a revenue-cycle team working within the provider's clinical and financial boundaries. Its reported claim results, controls, and pilot timing should not be treated as guarantees for another practice.

Romania-based revenue-cycle team

The billing team worked from Romania. The case separately describes access controls, coding review, and client-held decisions; none follows automatically from location.

Pilot first, scale on SLA proof

The pilot team proved clean-claim and denial-handling quality on a controlled pilot before scaling the full revenue cycle.

You keep the decisions

The provider kept clinical definitions, documentation policy, credentialing, and banking deposits. The billing team operated the revenue cycle around them.

Reported clean-claim and DSO results

The case records a 97.8% clean-claim rate and a 31% DSO reduction in this engagement. These figures do not compare every offshore billing provider or US in-house team.

Frequently asked questions

How did the billing team reach a 97.8% clean-claim rate and cut DSO 31%?

The managed revenue-cycle team ran eligibility, coding, claim submission and denial work-down to payer rules with maker-checker QA. The team reached a 97.8% clean-claim rate, cut days sales outstanding by 31% with client-held clinical decisions and approvals. (Actigy BPO-reported)

Where was the revenue-cycle team based?

The billing team worked from Romania. The described access controls and client-retained authority are engagement details, not consequences of geography. A new scope needs its own security and coverage review.

Did the provider keep clinical and banking control?

Yes. The billing team operated the revenue cycle around the client's controls. The client kept exclusive ownership of clinical definitions, documentation policy, provider credentialing and direct banking deposits.

What access controls did the billing team use?

The billing team worked inside the agreed systems with scoped access, role separation and audit logging. Client staff retained clinical decisions and final approvals. The case does not establish a certification or a general compliance guarantee.