How GetMax runs it, in practice.
Real revenue-cycle problems, and the approach GetMax takes to each — walked through end to end, so you can see the method before you see the results.
Denials climbing across specialties
The setting
A growing multi-specialty group where each specialty billed a little differently, and denials were creeping up without anyone able to say exactly why.
Where the revenue leaked
Eligibility gaps and coding mismatches were slipping through inconsistently, and denials were being reworked one at a time instead of prevented.
How GetMax runs it
- 01Move eligibility to real-time 270/271 at the front desk, before the visit.
- 02Scrub claims against payer-specific rules as codes are applied, not after.
- 03Read the CARC/RARC pattern on denials and fix the root cause upstream.
What changes
The point isn't a headline number — it's that the same denial stops recurring, because the step that caused it gets fixed once instead of appealed forever.
Revenue earned but frozen in DNFB
The setting
A hospital where discharged accounts sat un-billed while coding and documentation caught up — cash earned but stuck.
Where the revenue leaked
DNFB days stacked up, and high-dollar inpatient denials were being under-appealed because the volume outpaced the team.
How GetMax runs it
- 01Automate the routine coding and documentation follow-up that clears DNFB.
- 02Route high-dollar denials to specialists with the full claim story attached.
- 03Track institutional (837I) claims by status so nothing ages silently.
What changes
Frozen revenue starts moving again, and the appeals worth fighting actually get fought — because people aren't buried in the routine work anymore.
Prior auth and eligibility whiplash
The setting
A specialty practice where a large share of services needed prior authorization, and a missed or mismatched auth meant a guaranteed denial weeks later.
Where the revenue leaked
Auths were secured inconsistently, and coverage wasn't always re-verified when plans changed mid-year.
How GetMax runs it
- 01Verify coverage in real time and flag services that require authorization.
- 02Confirm the auth on file matches what's actually performed before billing.
- 03Keep the practice's own view of where each claim sits — no black box.
What changes
Preventable denials stop being a monthly surprise, and the front office spends less time on payer phone trees and more on patients.
The first real case study here could be yours.
We're taking on a small number of founding partners. Bring us the messy one — the specialty everyone else struggles with — and we'll run it, measure it honestly, and publish the real result together, with your consent.
See the method on your numbers. That's the only case study that counts.