Revenu Cycle Transformation - Shore HealthCare Consulting

A national Behavioral Health Provider partnered with Shore Healthcare Consulting (SHC) to stabilize billing, align operations, and modernize systems. SHC guided leadership and revenue cycle improvements, creating scalable infrastructure, predictable cash flow, and measurable results.

The Challenge

The organization was underperforming on revenue cycle fundamentals. Leaders lacked visibility into daily operations, limited reporting masked performance trends, and ineffective RCM leadership left cash flow unstable and deteriorating. After the acquisition, the client needed a fast and decisive course correction to stabilize billing and collections, restore cash predictability, and keep growth on course.

The Solution

SHC worked hand in hand with the team to uncover issues, set clear KPIs, and make progress visible. They introduced flash reports, Kanban, and Kaizen boards to drive accountability and improvement. SHC guided due diligence and implementation of a new EHR and practice management system, resolved payer disputes, and worked down legacy A/R. They also launched a Financial Hardship Program and a Patient Responsibility Collection Process, balancing accountability with compassionate support.

Key Objectives

Stabilize operations and cash flow
Stand up KPI-driven RCM culture
Accelerate clean-claim throughput
Resolve legacy A/R and payer issues
Support patient responsibility and hardship initiatives
Design and implement new EHR and RCM system

Approach

Uncover Data and Baselines

Spent time with both leaders and frontline staff to gain visibility into workflow. They rebuilt the data backbone, tracked charges, denials, and payments, and compared performance to best practices. By mapping pain points from intake to collections, Shore prioritized fixes that reduced rework, sped up revenue, and quickly brought stability to cash flow.

01

Rebuild Clean-Claim Velocity

They focused on getting clean claims out the door faster. They paused error-prone submissions, scrubbed them for accuracy, and re-released them in careful stages. With daily, weekly, and monthly flash reporting, the team could spot problems right away. Kanban boards kept work transparent, while Kaizen sessions captured and acted on new ideas to keep improvements moving forward.

02

Modernize Systems and Relationships

They helped modernize the platform and relationships. They guided the selection and rollout of a new RCM platform, worked down old accounts, and set up programs for patient responsibility and financial hardship. By reshaping payer relationships and resolving disputes, Shore built a steady operating rhythm designed to last beyond their engagement and drive long-term value for the sponsor.

03

Results

Stronger Cash and Aligned Teams

Payment-to-Charge Ratio improved from 68.6% to 100.4% within 12 months.
Revenue receipts climbed steadily from stabilization into optimization.
Clean claims accelerated collections, reducing volatility and creating predictable cash flow.
Patient-focused programs improved balance resolution and community trust.
KPI-driven culture improved accountability and performance across the RCM team.

“They helped rebuild our RCM department, improving collections, hiring leadership, and guiding new system implementations. Acting as interim head of RCM, they stabilized operations and transitioned out once the team was strong.”

— Principal, Private Equity Firm

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