- Case Study
The Switch to DME: 40% More Claims in Half the Time
- The Problem
The Client
An Inc. 5000-ranked healthcare organization seeking to improve claims operations after months of limited progress with a large, established offshore vendor. After nearly a year of engagement with a well-known outsourcing firm, the client began exploring more agile partners to strengthen their RCM performance.
The Challenge
Stalled Ramp-Up, Limited Insight, and Inconsistent Delivery: After months with a well-established offshore vendor, the client saw little progress in claims processing. Ramp-up was sluggish, and output failed to meet expectations. Despite significant onboarding time, basic claim workflows remained inconsistent, and teams lacked the adaptability to handle evolving processes. The vendor’s reporting provided only top-line volume metrics—offering no visibility into rejections, root causes, or performance breakdowns. Leadership flagged persistent knowledge gaps, communication lags, and an inability to scale with urgency. With rising pressure on RCM operations, the client launched a Champions Challenge to find a more capable and responsive partner.
- The Solution
The DME Service Solutions
Experienced Claims Experts
DME staffed the engagement with professionals who brought years of experience in claims processing, reprocessing, and denial management. All agents were vetted for payer knowledge, CPT coding familiarity, and documentation accuracy. This ensured that the team could begin contributing meaningfully with minimal lead time, requiring only client-specific training for full alignment.
Fast, Stable Ramp-Up
The team reached full productivity within the first six months, stabilizing at an average of 56 claims per day per agent. This result was achieved through a structured onboarding process, collaborative workflow clarification, and consistent operational oversight. Productivity gains were maintained without sacrificing accuracy, allowing for confidence in both output and quality.
Output-Based Billing
A productive-hour billing model was implemented, ensuring the client was only invoiced for time directly spent on claim-related tasks. This approach removed ambiguity around agent availability and allowed for precise tracking of labor utilization. The model also provided the client with full transparency and accountability on billed time.
Operational Reporting
To support decision-making and internal visibility, DME delivered regular reporting that detailed key metrics. These reports were structured to supplement internal systems and provide clarity on volume trends and productivity patterns. The cadence and structure of these updates were aligned with client preferences and integrated into operational reviews.
Built-In Compliance
DME operates with embedded compliance protocols across all workflows. The team is HITRUST r2, SOC 2, and ISO 27001 certified, and adheres strictly to HIPAA and PCI DSS standards. Workforce compliance includes monthly screening against the OIG Exclusion List and other sanctions databases, along with background checks conducted during onboarding. Access to client systems is secured via virtual desktop infrastructure, ensuring PHI protection.
Scalable Operating Model
Our operational framework was designed to scale in response to client needs, with a lean pilot team and expanding capacity based on performance benchmarks. Structured onboarding, dedicated support leads, and role-specific training enabled the team to absorb additional volume without disruption. This scalable approach allowed the client to confidently expand the engagement, doubling the number of billable FTEs and extending the scope.
- The Result
Productivity Growth Over Baseline in 6 Months
More Claims per day Compared to Previous Vendor
