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SCALE Automation Solutions
for RCM Operations

Automate your workflow, boost efficiency, and elevate patient care with SCALE Automation Solutions for RCM Operations—where innovation meets excellence.
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Our Approach

SCALE’s Holistic Approach to Cost Savings

Rising cost pressures, required infrastructure investments, and other payer and market headwinds are putting more pressure on MSO and physician practices. SCALE offers a range of cost-containment solutions tailored to empower MSOs with high-quality, cost-efficient operations.
Select Recent Case Studies:
  • RCM: ~50%+ cost-to-collect reduction.
  • Clinic Network Operations: ~$7 million annual expense reduction.
  • Payer Strategy: ~10% negotiated rate increase.
  • Marketing: ~$3 million (i.e., 27%) annual marketing spend reduction.

Key capabilities

SCALE Automation

SCALE Data Analytics

SCALE Healthcare Offshore Center

SCALE Consulting

MSOs Can Unlock Significant Quality and Efficiency Gains Through RCM Automation

Patient Access

Patient Referral Management, Patient Scheduling, Eligibility Verification

Claim Preparation

Claim Submission, Claim Status Check

Claim Submission

Claim Submission Claim Status Check

AR Management

EOB Indexing & Extraction, Payment Posting, AR Reporting

Lost Referrals

Scheduling delays, lost referrals, poor experience Automation of referral management can increase conversion rates by 25-50%.

High Denial Rate

Patient access processes cause 50% of denials. Potential savings of $25 per reworked claim. $300k/year*

Coding Errors

Coding errors are the cause of 15-20% of denials Automation can save over $60k/year** plus additional revenue capture. ** 5,000 claims per month

Missed Charges

Missed charges cause revenue leakage. Pre-submission review to check for incomplete charge capture.

Reimbursement Delays

Manual claim status is both costly and can delay payments (up to 20 days) Reduce time in AR and increase cash flow.

High Admin Costs

Automation can cut costs by over $500,000 a year.*** ***$10M in rev.; 20% RCM costs

Manual Payment Posting

Labor intensive and error prone process. Savings could range from 30-50% of total costs associated with payment posting.

Laborious Analytics

RCM departments spend ~40% of their time on data entry for reporting. Automated analytics can cut this time in half.

SCALE Automation Service Offerings

Patient Access

Referral Ingestion

Automatically upload referrals from all sources into your EMR for scheduling.

Claim Preparation

Dynamic Claim Queue

Continuously monitor billing software for claims ready for submission.

Claim Submission

Claim Auto Submit

Auto-submit based on criteria provided.

AR Management

Intelligent AR Manager

Segment and prioritize denials based on denial reasons, amount, and likelihood of appeal success.

Patient Access

Eligibility Discovery & Verification

Automatically discover and validate insurance pre-service.

Claim Preparation

Claim Validation

Automated checking of claims against pre-configured and customizable rules.

Claim Submission

Claim Monitoring

Automatically monitor all claims for reimbursement and status changes.

AR Management

Appeal Automation

Prepare appeals with missing documents for review and submission.

SCALE Addresses Common Challenges in Adopting Healthcare Technology Solutions

Why Traditional Approaches Fall Short

  • Expensive: In-house builds requires significant investments in infrastructure, software, and talent. Many MSOs lack the expertise to build scalable and effective solutions, resulting in wasted resources.
  • Time-Consuming Implementation: Projects can take months or even years, delaying the ability to generate actionable insights and realize ROI.
  • Lack of Healthcare-Specific Expertise: Many third-party consultants lack deep subject matter knowledge, which is critical in navigating complex healthcare data systems.
  • Unrealistic Expectations:: Vendors will often over-promise and under-deliver. Leaving you with an additional cost and uncertainty as to if all aspects of automation were worth the effort and cost.

SCALE's Approach

  • Cost-Effective: Avoid the high costs of in-house or traditional builds with SCALE's modular approach, allowing you to implement only the components you need, avoiding unnecessary expenditures.
  • Rapid Deployment: SCALE's streamlined processes and pre-built frameworks accelerate implementation timelines, enabling faster access to actionable insights.
  • End-to-End Expertise: SCALE's team includes healthcare subject matter experts who understand the nuances of revenue cycle management, patient workflows, and call center operations.
  • Modular: Build the custom technology solutions that best meet your business priorities and desired budget / pace. Implement one, several or all offerings.

SCALE’s Automation Approach

SCALE Brings a Unique Combination of Technology Solutions, Holistic Expertise and Reliable Processes

1-2 Weeks

  • Free Opportunity Assessment
    Review org. structure for cost reduction opportunities, core KPIs for process / people-oriented issues, and processes for bottlenecks.
  • Articulation of Potential Savings
    We will highlight the opportunities we see and the likely benefit you would experience from the automation of a function or process.

3-4 Weeks

  • Establish Baselines Measures
    Capture baseline KPI and productivity measures to determine if we achieved our projected ROI.
  • Document & Scrutinize Process
    We will work with your team to document the process we plan to automate. This process will be reviewed to ensure it meets expectations.
  • Implement Phase I Automation
    Develop automation in line with the documented and approved processes.

On-Going

  • On-Going Tracking of Results
    SCALE RCM Productivity Analytics will allow you to track the improvement and ongoing progress.
Category Current Cost Example Est. Savings % of Total Est. Additional Rev. Captured ROI Impact
Patient Access $150,000 $30,000 - $50,000 XX $25,000 - $30,000 Improved patient conversion, provider utilization, and labor savings
Claim Preparation $120,000 $45,000 - $75,000 XX $7,500 - $12,500 Reduced denials and faster payments
Claim Submission $95,000 $40,000 - $45,000 XX - Faster payment and reduction of costs related to manual work
AR Management $100,000 $40,000 - $45,000 XX $32,500 - $37,500 Increased collection efficiency
Total $465,000 $155,000 - $215,000 XX $65,000 - $80,000 Between $220,000 and $295,000 in increased cash flow due to automation

Cost Saving Illustration

Cost Saving Illustration

SCALE Data Analytics provides value driven technology solutions that help organizations monetize value from their data.

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