Practice Profile
- Specialty: Family Medicine/Primary Care
- Size: 6 physicians, 3 nurse practitioners
- Location: Seattle, Washington
- Annual patient volume: ~19,500 patients
- Practice type: Independent (not hospital-owned)
Challenge
Eastside Family Practice (EFP) was experiencing a steady increase in claim denials, reaching 16.8% by mid-2023, significantly impacting their financial stability as an independent practice. Their three-person billing team was overwhelmed, with one staff member dedicated almost exclusively to working denials. Most concerning was their declining clean claim rate (71.3%) and extended days in A/R (33.4 days), creating cash flow challenges that threatened the practice’s independence.
Specific pain points included
- High volume of diagnosis coding specificity denials
- Frequent rejections for preventive vs. problem-oriented visit distinctions
- Inconsistent documentation across providers
- Manual eligibility verification leading to coverage denials
- Limited resources for denial follow-up and appeals
Primrose.health Solution
EFP implemented Primrose.health’s AI-powered billing platform in April 2023
1. AI-assisted diagnosis coding
- Automated ICD-10 specificity recommendations
- Documentation gap identification
- Clinical validation of code selection
2. Preventive service optimization
- Automated detection of preventive/problem visit combinations
- Modifier recommendation engine
- Documentation template optimization
3. Front-end eligibility verification
- Real-time coverage verification
- Service-specific benefit checking
- Patient financial responsibility estimation
Results:
| Metric | Before Primrose.health | After 6 Months | Improvement |
|---|---|---|---|
Overall Denial Rate | 16.8% | 10.2% | 39.3% reduction |
First-Pass Clean Claim Rate | 71.3% | 94.7% | 32.8% increase |
Days in Accounts Receivable | 33.4 | 17.9 | 46.4% reduction |
Coding-Related Denials | 83 per month | 21 per month | 74.7% reduction |
Monthly Collections | $524K | $613K | 17.0% increase |
90+ Day A/R | $475K | $142K | 70.1% reduction |
Financial Impact:
- Additional revenue captured: $178,000 in first year
- ROI: 685% in first 12 months
- Billing staff productivity: 57% increase in claims processed per hour
Physician Owner Quote
As an independent practice, every dollar counts, and we were losing too many to preventable denials. Primrose.health’s AI system caught coding errors we didn’t even know we were making and identified patterns in our denials that weren’t visible to us. Beyond the financial improvement, what’s been most valuable is how the system has become more intelligent about our specific practice patterns over time. It’s not generic – it’s learned our providers’ documentation styles and gives targeted recommendations. The ROI has been exceptional, and the system continues to improve month over month.” – Dr. Sarah Chen, Physician Owner, Eastside Family Practice.