Real practices. Measurable results.
Illustrative examples of how our process tackles common billing challenges — by specialty, challenge, and outcome.
Denial Rate
14.2%
3.8%
AR Days
47 days
21 days
Net Collections
Baseline
+22%
Admin Hours Saved
—
31 hrs/wk
The Challenge
A cardiology group came to Aethera with a 14.2% denial rate — driven almost entirely by cardiac catheterization modifier errors and bundling issues on stress testing codes. Their AR had ballooned to 47 days, and a recent billing staff departure left a three-month gap in denial follow-up. An estimated $40,000/month was being written off without appeal.
The Solution
Aethera assigned a dedicated cardiology coding team that rebuilt their modifier matrix for the entire 93000-series. We implemented real-time eligibility checks pre-appointment and created a payer-specific rules library covering their top 8 payers. The backlog of unappealed denials was worked through systematically over 60 days.
"We were writing off $40,000 a month in denials we assumed were uncollectable. Aethera recovered most of it in the first 60 days — and then made sure it wouldn't happen again."
Clean Claim Rate
78%
96.4%
Denial Rate
16%
4.1%
Monthly Collections
Baseline
+$18,200
Admin Burden
High
Minimal
The Challenge
A family medicine practice had been relying on front desk staff to handle billing alongside scheduling and patient intake. Their clean claim rate was 78% — 17 points below industry standard — and there was no systematic denial follow-up. A coding audit revealed consistent undercoding on complex office visits: 99214s being submitted as 99213s, 99215s as 99214s.
The Solution
Aethera took over the complete billing function and ran a 90-day coding audit that identified the undercoding pattern across 8 months of historical claims. We rebuilt the physician's E&M documentation templates, educated the provider on MDM-based coding, and implemented a denial tracking dashboard in the provider portal.
"I was essentially giving away $200,000 a year because my front desk was coding every visit at the same level. I had no idea until Aethera showed me the data."
Implant Revenue Captured
Inconsistent
+$124K/yr
AR Days
52 days
28 days
Payer Audit Flags
2 per year
0
Global Period Violations
Frequent
Eliminated
The Challenge
An orthopedic practice with high implant volume was experiencing significant revenue leakage from two sources: inconsistent implant cost capture (missing invoice-level documentation for implants billed under C-codes and L-codes) and repeated global period violations triggering payer audits. Their AR stood at 52 days, and they had received two payer audit letters in 18 months.
The Solution
Aethera built a procedure-specific charge capture checklist that required implant invoice reconciliation before claim submission. A global period tracking module was implemented in their PM system, flagging any claims that risked modifier conflicts. The audit response team handled both pending audit letters, resulting in no recoupment.
"The implant billing alone paid for Aethera's fees ten times over in the first year. And the audit letters stopped completely."
Denial Rate
18%
4.3%
Mohs Reimbursement
Baseline
+31%
Reconstructive Claims
Written off
+$9,800/mo
AR Days
39 days
19 days
The Challenge
A dermatology practice with high Mohs surgery volume had been miscoding Mohs staging procedures for years — submitting single-stage codes without the required block and specimen-count add-ons. Additionally, reconstructive cases were being written off because documentation didn't meet medical necessity standards for their top two payers. Their denial rate was 18%.
The Solution
Aethera assigned a Mohs-specialist coder who rebuilt the practice's procedure coding from the ground up. We created documentation templates specifically designed to satisfy reconstructive necessity criteria for each of their top payers. A payer-specific Mohs rule library was maintained and updated quarterly.
"We'd been coding Mohs the same way for seven years and nobody told us it was wrong. Aethera fixed it in 30 days and we haven't had a Mohs denial since."
Bundling Denials
Frequent
Eliminated
Prior Auth Approval
66%
89%
Patient Collections
Baseline
+340%
Net Revenue
Baseline
+$31K/mo
The Challenge
A behavioral health group was struggling on three fronts: E&M and psychotherapy claims were triggering bundling edits on major payers, prior authorization denials for newer psychiatric medications were running at 34%, and patient collections were functionally nonexistent — balances were either written off or sent to collections with no intermediate step.
The Solution
Aethera restructured the group's claim submission logic to properly unbundle therapy and medication management per payer policy. A prior auth workflow was built specifically for the psychiatry formulary, with escalation paths for denials. A four-step patient statement series with a soft-touch phone follow-up protocol was implemented for all patient balances over $50.
"We weren't collecting from patients at all — we'd write it off rather than have an uncomfortable conversation. Aethera built a system that collects professionally without damaging the therapeutic relationship."
Days to Go Live
45 day target
38 days
Clean Claim Rate (Day 1)
—
95.8%
Setup Fees
Expected
$0
Cash Flow Gap
Major concern
None
The Challenge
An internal medicine group was transitioning from hospital-employed billing to independent billing following an ownership change. They had no existing billing infrastructure, providers who needed credentialing with their new TIN, and a hard go-live date 45 days out. Cash flow continuity was the primary concern.
The Solution
Aethera executed a full build-out of the billing infrastructure: credentialing for all providers simultaneously, eClinicalWorks integration configuration, fee schedule loading, and payer enrollment. Claims began processing on day 38 — two days ahead of the hard deadline. A dedicated project manager coordinated across all workstreams.
"Aethera built our entire billing operation from scratch in under 6 weeks. Every provider was credentialed, the system was live, and we didn't miss a single payment cycle."
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