Automated Revenue Cycle Management Recovering $1.4M for a Multi-Site Healthcare Provider
A multi-site healthcare provider automated claims processing, denial management, and patient billing with Dynamics 365 — recovering $1.4M annually.
About the Client
The Challenge
The healthcare provider's revenue cycle was hemorrhaging money. Claims were submitted manually from 4 clinic locations, each with slightly different coding practices. Denial rates ran at 18% — nearly double the industry average of 10%. When claims were denied, the follow-up process was a spreadsheet tracked by two billing managers who couldn't keep up with the volume.
Accounts receivable aged past 90 days represented $3.2M — cash the organization desperately needed for facility upgrades and physician recruitment. The CFO commissioned an audit that found 60% of denials were preventable: incorrect patient demographics, missing prior authorizations, and coding errors that could have been caught before submission.
The organization needed a system that could catch errors before claim submission, automate denial follow-up workflows, and give the CFO real-time visibility into the revenue cycle — not month-end reports that arrived 3 weeks after the fact. They evaluated several ERP platforms and selected Dynamics 365 for its healthcare industry accelerator and Power Platform integration.
Our Approach
We implemented D365 with custom healthcare revenue cycle workflows in 4 phases:
Assessment & Configuration (Weeks 1-4)
Mapped existing revenue cycle workflows across 4 clinics. Configured D365 with healthcare-specific entities: claims, encounters, authorizations, and denial reasons. Set up payer-specific rules for Medicare, Medicaid, and 12 commercial payers.
Claims Automation (Weeks 4-8)
Built Power Automate flows for pre-submission validation: demographic verification, prior auth checks, coding compliance rules. Claims failing validation routed to billing staff with specific error details — not rejected silently.
Denial Management (Weeks 7-12)
Automated denial tracking with categorization by root cause, payer, and clinic. Built escalation workflows — denials untouched for 5 days auto-escalate to billing manager. Created appeal letter templates with auto-populated claim data.
Dashboards & Training (Weeks 10-16)
Deployed Power BI revenue cycle dashboards: denial rates by payer/clinic/reason, AR aging, cash forecasting, and staff productivity. Trained 45 billing staff across 4 locations.
Solution Architecture
Platform: Dynamics 365 with healthcare revenue cycle customization + Power Platform automation layer
Automation: Pre-submission claim validation → denial auto-categorization → escalation workflows → appeal generation → payment posting reconciliation
Analytics: Power BI dashboards for real-time revenue cycle visibility across all 4 clinic locations
Results
Technologies Used
Key Takeaways
If your organization is facing a similar challenge, here's what we learned:
Pre-submission validation prevents more denials than post-submission follow-up. Catching errors before the claim leaves your building is 10x cheaper than appealing a denial after the fact. Our Power Automate validation rules eliminated 60% of preventable denials.
Denial categorization reveals systemic issues. When you can see that 40% of Medicare denials at Clinic 3 are for missing prior authorizations, you fix the process — not just the claim. Root cause analysis turns reactive billing into proactive revenue protection.
Staff adoption requires role-specific dashboards. Billing clerks need work queues. Managers need exception reports. The CFO needs cash flow forecasts. Same data, different views — and each view was designed with its audience in the room.
Revenue cycle improvement is ongoing, not a one-time project. We established a monthly review cadence where the billing leadership team reviews denial trends, payer-specific patterns, and process improvements. The D365 platform gives them the data to drive continuous improvement.
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We automate claims processing, denial management, and AR follow-up — so you recover what you've earned.