Client: Fortune 500 Primary Care Organization | Scope: Medical Coding Operations | Scale: Hundreds of sites, nationwide | Timeline: 60 days
A Fortune 500 primary care organization running hundreds of sites nationwide had fallen two months behind on medical coding. The backlog was stalling claim submission, delaying reimbursement, and leaving leadership without a dependable view of performance or risk. Advantum Health rebuilt the coding operation end to end, aligning staffing to real volume, installing a continuous quality assurance framework, and delivering the executive reporting the organization had been missing. Within 60 days the backlog was cleared, turnaround stabilized at two days or less, coding accuracy reached 97 percent, and coding-related denials were eliminated entirely.
The Challenge: A Scaled Operation in Crisis
A two-month coding backlog had built up across hundreds of sites, and it was stalling claim submission and delaying reimbursement at every one of them. At this scale the financial drag compounded quickly. Every chart that sat uncoded represented revenue the organization had already earned but could not yet collect.
The deeper problem was visibility. Reporting was limited, so leadership had no clear read on productivity, quality, or risk, and no way to tell where the backlog was worst or whether any corrective effort was actually working. Communication gaps between the coding teams and stakeholders had worn down trust on both sides.
Most critically, there was no defined baseline and no consistent governance. Without either, there was no way to measure improvement or hold anyone accountable. The organization did not simply need to catch up on volume. It needed a coding operation it could see, measure, and steer.
The Solution: How We Rebuilt It
Advantum rebuilt the coding operation around a structured model designed to restore performance, improve visibility, and enforce accountability across the entire medical coding function. Four workstreams ran in parallel.
- Aligned staffing. Staffing was matched to actual volume demand rather than a fixed headcount. That alignment drove rapid backlog reduction and stabilized turnaround at two days or less.
- Continuous QA. A consistent quality assurance framework, built on 10 percent chart audits and weekly coder education, pushed accuracy up and pulled variability down across every site.
- Operational reviews. Bi-weekly reviews tracked backlog status, identified documentation gaps, and surfaced coding opportunities that would otherwise have gone unnoticed across the network.
- Executive reporting. Monthly executive reporting gave leadership a clear, ongoing view of productivity, quality, and the specific areas targeted for continued improvement.
The Results: Benchmark Performance in 60 Days
- 100 percent reduction in coding-related denials
- 97 percent coding accuracy
- 120 encounters coded per coder, per day
- Two days or less claim turnaround time
Within a single 60-day engagement, the backlog was fully cleared and the operation was running on benchmark footing. Coding accuracy reached 97 percent, productivity climbed to 120 encounters per coder each day, and turnaround held at two days or less. Coding-related denials were eliminated entirely. Just as important, leadership gained the baseline, governance, and reporting needed to sustain that performance and keep building on it. This is the kind of outcome a disciplined approach to denial management and coding governance is built to produce.
Talk to Advantum About Your Coding Operation
If a coding backlog is holding up your claims and clouding your view of performance, Advantum Health can help you rebuild the operation and get reimbursement moving again. Explore our medical coding services or review the full revenue cycle management guide to see how the pieces fit together.