How DeltaRCM Increased Collections by 15% for a Multi-Location Podiatry Practice

Sun Health Podiatry Group operates four thriving locations across the region, treating thousands of patients annually for everything from diabetic foot care to complex ankle reconstructions. Yet behind the clinical success lay a financial hemorrhage: denials were climbing, reimbursements were stalling, and the practice was leaving hundreds of thousands on the table. Within six months of partnering with DeltaRCM, the group recovered $420,000 in lost revenue and fundamentally transformed how they manage their billing operations.

The Challenge: When Clinical Excellence Doesn't Translate to Financial Health

Sun Health Podiatry Group's physicians were delivering exceptional care across four locations, but their revenue cycle was fractured. Each location operated with its own billing staff, creating inconsistency in coding practices, modifier application, and denial follow-up. The practice lacked centralized visibility into their financial performance—a critical vulnerability for any multi-location operation.

The numbers told a troubling story. The practice was sitting with an 18% denial rate, well above industry standards for podiatry (which typically hover around 8-12%). More concerning, their accounts receivable were aging at 45 days, meaning cash wasn't flowing back into operations fast enough to reinvest in patient care or staff. Claims were getting lost in the shuffle, and by the time billing staff noticed, many had already sailed past timely filing deadlines—making them uncollectable.

A deeper audit revealed the root causes. The practice's billing team, while well-intentioned, lacked specialized expertise in podiatry-specific coding complexities. Surgical modifiers (particularly the 51 modifier for bilateral procedures and the 59 modifier for distinct procedural services) were being applied inconsistently. DME billing—a significant revenue stream for practices fitting custom orthotics and diabetic shoes—was essentially abandoned, sitting in a backlog of unprocessed claims. And six months of aged claims had accumulated, many beyond the 180-day recovery window.

The financial impact was staggering. Conservative estimates suggested the practice was leaving $25,000-$30,000 per month on the table through denials, underpayments, and missed DME revenue. Over a year, that translated to nearly half a million dollars in lost collections.

Our Approach: Specialized Expertise Meets Systematic Process

DeltaRCM's engagement began with a comprehensive RCM audit across all four locations. The team identified specific coding patterns, denial trends, and workflow breakdowns. The findings were clear: this wasn't a technology problem—it was an expertise and process problem.

Building a Dedicated Podiatry Billing Team

DeltaRCM deployed a dedicated team with deep CPT expertise specific to podiatry procedures. This team understood the nuances of codes like 28296 (surgical treatment of hallux limitus), 28308 (revision of hallux limitus), and the complex modifier requirements that govern their use. They recognized that many of Sun Health's denials stemmed from improper modifier sequencing and missing medical necessity documentation.

Implementing Automated Modifier Validation

The practice implemented automated validation workflows that caught modifier errors before claims left the office. The system flagged:

• T codes (bilateral procedure indicators) when both feet were being treated
• 51 modifiers (multiple procedures) when bundling rules required them
• 59 modifiers (distinct procedural services) when procedures needed to be billed separately to avoid automatic bundling

This automation reduced claim errors by 85% within the first month and prevented thousands in downstream denials.

Clearing the Aged A/R Backlog

DeltaRCM's team systematically worked through six months of aged claims. They resubmitted claims that had been lost in the system, appealed denials with proper documentation, and recovered underpayments where insurance companies had paid less than contractual rates. This effort alone recovered $180,000 in previously written-off revenue.

Establishing DME Billing Workflows

Custom orthotics and diabetic shoes represent significant revenue for podiatry practices, but they require specialized billing knowledge. DeltaRCM set up dedicated DME workflows, ensuring that:

• Proper L codes (orthotic device codes) were used
• Medical necessity was documented in the chart
• Prior authorization requirements were met before dispensing
• Claims were submitted with appropriate supporting documentation

Within three months, the practice's DME collections increased by 40%.

Weekly Denial Review and Root Cause Tracking

Perhaps most importantly, DeltaRCM established a weekly denial review process with detailed root cause analysis. Rather than simply resubmitting denied claims, the team identified why denials were occurring and implemented preventive measures. Common denial reasons were tracked in a dashboard, allowing the practice to see patterns and address systemic issues.

The Results: From Financial Drain to Revenue Engine

Over six months, Sun Health Podiatry Group's financial performance transformed dramatically. The practice achieved a 15% increase in net collections, translating to approximately $420,000 in additional revenue. The denial rate plummeted from 18% to 4.5%—a 75% reduction that positioned the practice well above industry benchmarks.

Equally important, cash flow accelerated. Days in A/R dropped from 45 to 24 days, meaning the practice was converting claims to cash nearly three weeks faster. This improvement freed up working capital that could be reinvested in clinical operations and staff development.

The clean claim rate climbed from 82% to 96%, meaning the vast majority of claims were now being processed without denial on first submission. This metric is particularly important because it reflects the upstream quality of the billing process—fewer denials mean less staff time spent on appeals and resubmissions.

Monthly Performance Progression

Key Takeaways

• Specialized expertise matters: Podiatry billing has unique complexities (bilateral modifiers, DME coding, surgical procedure bundling) that generic billing teams often miss. Deploying dedicated expertise reduced denials by 75%.

• Multi-location practices need centralized oversight: Inconsistent coding practices across four locations were a major driver of denials. Centralizing billing operations under DeltaRCM created consistency and accountability.

• Aged A/R is recoverable revenue: The $180,000 recovered from six months of aged claims demonstrates that many "lost" claims can be salvaged with proper follow-up and appeals.

• Process improvements compound: Automated modifier validation, weekly denial reviews, and dedicated DME workflows didn't just fix immediate problems—they created sustainable systems that continue to drive results.

Looking Forward

Sun Health Podiatry Group is now exploring additional optimization opportunities with DeltaRCM, including predictive analytics to identify high-risk claims before submission and expanded credentialing support as the practice considers opening a fifth location. The partnership has evolved from crisis management to strategic growth—the practice can now focus on clinical excellence while their financial operations run like a well-tuned engine. With a 4.5% denial rate and 24-day A/R cycle, Sun Health is positioned to scale confidently, knowing that revenue cycle excellence is supporting their clinical mission.