How a Multi-State ABA Clinic Fixed Its Billing Struggles by Replacing Its RCM Vendor with Problem Solvers

Lacuna worked with multiple billing vendors, each promising better results but failing to deliver a lasting solution. One vendor reduced costs but left collections at just 40%. Another improved collections to 70%, but improvements plateaued, and the Lacuna team was constantly troubleshooting. Their billing meetings often focused on fixing immediate issues rather than identifying systemic problems, leaving the team without clear ownership over long-term improvements.

Adding to the frustration, denied claims were rarely investigated and prior authorization issues were mismanaged, forcing Lacuna to navigate constant delays and resubmissions. Past vendors operated reactively, providing no proactive guidance to prevent problems before they escalated.

After previous billing vendors failed to deliver long-term improvements, Lacuna approached us with caution. Our partnership approach focuses less on quick adjustments, and more on the root causes of billing inefficiencies. Unlike past vendors who operated independently, we take a more collaborative approach, working directly with Lacuna's leadership to ensure any proposed changes align with their operational and clinical requirements.

An example of this stemmed from a learning we surfaced during implementation: Lacuna's team was hand-editing claims to select the correct modifier for the service and payer. We partnered to reduce both time-spent and potential for error, creating validation rules based on our database of millions of claims for their payer set, as well as a diagnostic of Lacuna's historic data.

Every single time we came to the table, every single week, it wasn't, 'Hey, you guys need to do this. Hey, you guys need to do that.' It was like, 'Here's the problem identified. Here's three solutions. Do you guys have any other ideas?'

Alex, CEO of Lacuna Autism Services

We demonstrated our commitment to a true partnership early on by conducting an in-depth diagnostic of Lacuna's revenue cycle within 72 hours. We uncovered critical inefficiencies, including errors in split billing, missing denial patterns, and overlooked claims. Rather than simply presenting findings, we provided a clear, actionable plan to address these issues, reinforcing a hands-on, problem-solving approach before going live.

In that moment, I was like, 'okay, the amount of information they came back with was essentially the three years of struggling that we've been going through, and they provided a solution.'

Alex, CEO of Lacuna Autism Services

With real-time claims tracking, Lacuna could see exactly where revenue was getting lost. Our automation tools didn't just clean up claims -- they prevented denials before they even happened. And with a smart task management system, the team could now tackle issues before they spiraled into bigger problems.

Now that Lacuna's billing is running smoothly, the focus is on expansion. With our trusted partnership, they're exploring multidisciplinary services like PT, OT, and speech therapy -- without worrying about revenue bottlenecks.

By mid-2024, Anthem recognized Lacuna as the #1 Medicaid provider in the state of Nevada, awarding them a sizable reimbursement check for their operational improvements. With us in their corner, Lacuna is primed for sustainable, scalable growth.

It wasn't a package -- it was, 'Let's go solve these problems together,' and that's what's evolved over time.

Alex, CEO of Lacuna Autism Services