A private hospital group, three facilities, single-country. Insurance receivables at 94 days; rejection rate in double digits. Time horizon: seven months.
The diagnosis
Billing was blamed and billing was not the cause. Two-thirds of rejections traced back to data captured — or not captured — at admission, hours before any coder saw the file.
The admissions team had no visibility of which payer required which field, and no feedback loop from rejection back to the desk that had caused it.
The transformation
We redesigned admission as a payer-aware process, with validation at the point of capture and a weekly rejection review that named the originating step rather than the department.
The technology work was modest: field-level validation, one integration, and a dashboard that the admissions supervisor — not the CFO — reads every morning.
We had been trying to fix this at the end of the process for three years.
What we learned
The dashboard mattered less than who owned it. The change held because the metric sat with the supervisor whose team caused the defect.
We would run the rejection review manually for longer before automating it. The manual version taught the team what the automated version later enforced.