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by | Jan 15, 2026

Orthopedic PPM Case Study

Northeast Orthopedic PPM Achieves Sustainable Growth and Operational Excellence with AI-Powered RCM Transformation

About

Ascent Health partnered with a leading orthopedic PPM in the Northeast that empowers orthopedic and spine physicians to deliver high-quality patient care while accelerating clinical and operational performance. With 11 locations, 175 physicians, 5 surgery centers, and over 225,000 annual patient visits, the organization continues to expand its presence across the region through a team of 1,500 dedicated employees.

To strengthen its financial performance and modernize its revenue cycle operations, the PPM engaged Ascent Health to lead a comprehensive RCM transformation—one designed to accelerate revenue growth, reduce the cost to collect, and establish a scalable operational foundation for long-term success.

Challenges

Northeastern Orthopedic PPM faced a number of inherited RCM inefficiencies that limited scale and performance:

Fragmented and Unintegrated RCM Functions

Highly fragmented processes and uncoordinated local leadership led to inconsistent outcomes and rising administrative costs.

Vendor Performance and Cost Pressures

Existing vendor models and increased internal FTEs raised costs to collect, prompting the need for a scalable outsourcing strategy.

Operational Bottlenecks

Manual prior authorization, inconsistent coding workflows, and redundant claim follow-up processes increased aging AR and denials.

Data Silos and Workflow Inefficiencies

Unstructured data and disconnected reporting tools hindered visibility into key metrics such as Days in AR, Denials, and GCR.

Strategic Solution: Outsourcing to Scale

To address these challenges, Northeastern Orthopedic PPM partnered with Ascent Health to establish an AI-driven, outsourced RCM framework that positioned the organization for sustainable growth.

Global Capability Center and AI Transformation

Ascent developed a Global Capability Center (GCC) and GenAI Center of Excellence (COE) that unified process automation, data analytics, and AI-based performance tracking.

The initiative included:

  • Cross-departmental collaboration and innovation programs
  • Risk-based SLA structures for accountability
  • Process automation COEs for AR, denials, and coding management
  • Comprehensive ROI measurement for each RCM stream

Systematic Innovation Framework

A structured process with defined milestones ensured accountability and pace. Each cycle progressed through vertical leadership approval, SME-led design, and COE validation before pilot and execution phases.

Key Wins in the First Year

  • Increased pace and accuracy in collections
  • Reduction of aging AR and controllable write-offs
  • Growth in Gross Collection Rate (GCR) by 2.1%
  • Streamlined and structured RCM processes across departments

Results & Outcomes

$10.7M

Revenue Increase

~ 40%

Reduction in Coding Time

60%

Reduction in Touches per Claim

~ 70%

Reduction in Review Time for Prior Authorizations

QUANTIFIABLE IMPACT

  • Estimated RCM Cost to Collect: Reduced 1.5%
  • Untouched Inventory Reduction: 80%
  • Claims Follow-up Time Reduction: 80%
  • GCR Improvement: +2.1%

OPERATIONAL EFFICIENCY

  • 100% real-time audit completion for surgical procedures
  • Automated AR follow-up and claim status tracking
  • Days in AR reduced from 70 to 30 days

Ascent Health’s partnership has transformed Northeastern Orthopedic PPM’s revenue cycle into a data-driven, AI-empowered engine for growth and efficiency. Through structured governance, risk-based outsourcing, and measurable outcomes, the orthopedic partner now stands as a benchmark for scalable, sustainable RCM excellence in the healthcare industry.

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