Capture RCM OperationsA Kentucky TRP and IOP provider was drowning in denials — 30% of claims bouncing, cash flow collapsing. They were self-billing and didn’t know why.
We audited their EMR and clearinghouse settings and found the problem wasn’t their billing — it was modifier sequencing, missing taxonomy codes, and bundling errors baked into their configuration. We fixed it at the source.
Denials dropped to under 12%, and the fix was permanent. The next batch of claims didn’t come back denied the same way.
Full story: Read Case Study 1 →
Capture RCM OperationsA South Carolina behavioral health provider’s clinicians were strong — but their documentation wasn’t carrying the weight of the clinical work. Patients were being authorized for less time than they needed, not because the care wasn’t necessary, but because the paperwork didn’t prove it.
Our UR team worked side by side with their clinical staff, showing them exactly what was missing — down to the treatment plans and the clinical detail that justifies each service and each additional day of care. We also coached their providers on running successful peer-to-peer reviews, so authorizations get approved on the call instead of denied and appealed later.
The result: more approved days of care, patients staying in treatment for the time they need, and peer-to-peer reviews winning on the first call.
Full story: Read Case Study 2 →
Capture RCM OperationsWhen a prior authorization gets denied for medical necessity, most providers file an appeal and wait. But there’s a faster path — the peer-to-peer review, where your clinician talks directly with the payer’s medical reviewer.
Most clinicians are trained to document for the chart, not to advocate for the claim. They open with the diagnosis code instead of the clinical picture. They answer the reviewer’s questions literally, without connecting symptoms to the specific services requested.
We coach providers on how to open with the patient, not the paperwork — and how to connect every service to a documented symptom. One example: a patient in IOP was approved for only two weeks, then lost his job. His father was caring for his children, and their mother was an addict not seeking recovery. Without structure and support, relapse was the predictable outcome.
The peer-to-peer review won additional days of IOP. The patient stayed in treatment through a critical window.
We don’t measure success by claims paid. We measure it by patients who stay in treatment.
Full story: Read the Peer-to-Peer Spotlight →
Susan WennerMost RCM companies take over your billing, resubmit your denials, and disappear. That’s not what we do at Capture RCM Operations.
I built this company because I watched behavioral health providers — people who dedicate their lives to helping others — get crushed by a system they never signed up to fight. They were trained to treat patients, not to navigate modifier sequencing, taxonomy codes, and payer criteria.
And here’s what else is different: I’m not behind a desk delegating your account to a team. I work directly with our clients — on site, in their programs, in their curriculum. Most owners of RCM companies off-board that to staff. I don’t. When you call Capture RCM Operations, you get me.
We work inside your program and curriculum structure, not just your claims. When services are built to be billable from day one, denials don’t pile up — they never happen. That’s the difference between managing denials and preventing them.
It’s a partnership, not a transaction. And it’s why our clients’ cash flow stabilizes and their teams stop burning out.
If you’re a behavioral health provider drowning in denials, let’s talk.
