From backlogged and bleeding to clean and current
Rebuilding the revenue cycle for an independent California family practice — measured entirely from the practice's own Tebra data, anonymized and expressed in percentages, day-counts, and indexed growth.
Comparison windows: Before = the six months before go-live (Jan–Jun 2024). After = a full six months under Quantix (Jul–Dec 2025). Ratios and day-counts are reported rather than dollar totals, because claim volume grew substantially over the period.
Practice profile
The client is an independent family medicine practice in the Inland Empire, delivering a high volume of visits through a single rendering physician. The payer base is Medi-Cal managed care heavy: roughly four out of five charge dollars route through Inland Empire Health Plan (IEHP), with Medicare Part B making up close to one in ten and a smaller commercial tail (Blue Cross of California, Health Net, Aetna, Cigna). It is a classic high-volume, thin-margin, government-payer practice where clean claims, disciplined follow-up, and fast charge capture are the difference between a healthy cash position and a spiral of aged, unworked accounts.
The starting problem
When Quantix Health took over the revenue cycle in July 2024, the practice carried the hallmarks of a billing operation that had fallen behind. Every report told the same story:
- Charges were entered ~3 months after the date of service. Charge lag measured about 86 days — revenue sat uncaptured for a full quarter before a claim went out.
- The insurance A/R was severely aged. About 71% of open insurance receivable sat in the 120-plus-day bucket, where collectability drops sharply and timely-filing windows start to close.
- Denials were dominated by preventable process failures. Duplicate claims and expired timely-filing accounted for roughly 80% of denial dollars — workflow problems, not clinical or payer problems.
- Adjustments were written off without reason coding. About 86% of adjustment dollars landed in an unclassified bucket, making it impossible to separate a true contractual write-down from lost revenue.
These symptoms traced back to upstream breakdowns on both sides of the claim: missed eligibility checks, absent prior authorizations, and incorrect patient and insurance information at intake, compounded by inconsistent follow-up in the prior billing process. Claims were going out wrong — or not going out at all — before anyone worked a denial.
What Quantix did
We treated the engagement as a stabilize-then-optimize rebuild, not a lift-and-shift of the existing process:
- Cleared the unbilled backlog — entered and processed a significant volume of encounters that had never been billed, and surfaced missed billing opportunities so outstanding visits were submitted for reimbursement.
- Compressed charge capture so charges post close to the date of service, cutting timely-filing risk at its source.
- Attacked the denial root causes — eliminated duplicate submissions, tightened eligibility and prior-authorization checks, and rebuilt filing discipline, turning the denial profile from preventable errors into a normal, mostly contractual one.
- Restored adjustment integrity — re-coded write-offs to real contractual and payer reasons, so expected-vs-collected is finally visible and underpayments become appealable.
- Implemented MIPS quality measures and applicable incentive opportunities to improve quality reporting and maximize available reimbursement.
- Trained the front office — on-site staff training on documentation, coding, charge capture, and billing requirements, so clean claims start at intake rather than getting fixed downstream.
- Stood up ongoing reporting — KPIs, aging, denials, and payer mix are now tracked on a repeatable cadence.
Before vs. after Quantix
| Metric | Before (H1 2024) | After (H2 2025) | Change |
|---|---|---|---|
| Days in A/R (Tebra) | 32.4 days | 15.8 days | −51% |
| Insurance A/R over 120 days | 70.7% | 30.6% | −40 pts |
| Insurance A/R over 90 days | 71.5% | 33.6% | −38 pts |
| Charge lag (days to bill) | 86.4 days | 37.7 days | −56% |
| Preventable denials, share of denial dollars | 80% | 3% | −77 pts |
| Adjustments left in unclassified Default/Unspecified | 86.4% | 26.9% | −60 pts |
How to read the headline: the cleanest single number is Days in A/R, which Tebra calculates directly and which fell from about 32 to about 16 days. Alongside it, the oldest and least-collectible layer of insurance A/R (the 120-plus bucket) shrank from about 71% to about 31%, and the preventable-denial problem effectively disappeared.
Why a few numbers are still moving
We report these honestly rather than rounding them off, because each has a real, improving cause:
- Charge lag (~38 days). This is now driven mainly by clinical documentation timing, not billing throughput — documentation workflows are being tightened, and note sign-off can occasionally run longer. As sign-off compresses, charge lag continues to fall; the billing side already posts within days of receiving a completed note.
- Insurance A/R over 90–120 days (~31–34%). Two things keep these buckets above 30%. First, this is a Medi-Cal managed-care (IEHP) book, where adjudication, coordination-of-benefits, and resubmission cycles simply run long, so legitimately in-process claims age past 90 days before they pay. Second, claim volume grew substantially over the period — a larger, faster-growing charge base keeps fresh receivable flowing into the denominator while the legacy backlog is still being worked to closure.
Both are trending in the right direction and are actively managed on the reporting cadence above.
Collections grew nearly 5×
Total collections per six-month period, indexed to the six months before go-live (H1 2024 = 1.0×) to keep the practice anonymous. Quantix took over the revenue cycle in July 2024 — the first full period under Quantix (H2 2024) nearly tripled the prior half.
In under two years, Quantix Health took a family practice whose billing was months behind, whose receivable was dominated by aged claims, and whose denials were mostly self-inflicted — and turned it into a revenue cycle that posts current, ages cleanly, and denies for normal contractual reasons rather than preventable errors. The work of collapsing the unapplied backlog and closing the aged-claim tail continues, and the reporting is now in place to prove it.
Quantix took our billing from months behind to current, and for the first time we can actually see where our money is.