How Acuity Health Improved Prior Authorization and Oculoplastic Revenue Tracking for an Austin-Based Plastic & Reconstructive Surgery Clinic
Case Study: Specialty RCM Support for Plastic Surgery, Reconstructive Surgery, Oculoplastics & Ophthalmology
Overview
An Austin-based plastic and reconstructive surgery clinic partnered with Acuity Health Solutions after identifying revenue inconsistencies across its specialty service lines.
The clinic offered a wide range of services, including plastic surgery, reconstructive surgery, oculoplastic procedures, ophthalmology-related care, breast reconstruction-related cases, and non-surgical treatments. While the practice had strong clinical expertise and steady patient demand, leadership felt that certain departments were not reflecting their full revenue potential.
The biggest concern was around two areas:
- Prior authorization issues across specialty procedures
- Lower-than-expected revenue performance from the oculoplastic and ophthalmology-related department
The practice needed more than routine billing support. They needed a specialty RCM partner who could review historical patterns, identify operational leakage, and build a more trackable workflow around prior authorizations, eligibility verification, documentation, and claim readiness.
Acuity Health stepped in to bring structure, visibility, and accountability to the process.
The Situation Before Acuity
Before Acuity’s involvement, the clinic was dealing with avoidable revenue leakage caused by front-end process gaps. The leadership team had a strong sense that something was off. The oculoplastic and ophthalmology-related department was seeing patients and performing procedures, but the numbers did not fully align with the expected output. At the same time, prior authorization issues were affecting multiple specialty offerings across the practice. In a surgical environment, this can create major downstream problems.
A missed authorization, incomplete eligibility check, or delayed payer follow-up can lead to:
Delayed procedures
Denied claims
Rework for staff
Confusion around patient responsibility
Increased A/R
Lower collection predictability
Frustration for providers and administrators
Before Acuity’s involvement, the clinic was dealing with avoidable revenue leakage caused by front-end process gaps. The leadership team had a strong sense that something was off. The oculoplastic and ophthalmology-related department was seeing patients and performing procedures, but the numbers did not fully align with the expected output. At the same time, prior authorization issues were affecting multiple specialty offerings across the practice. In a surgical environment, this can create major downstream problems.
A missed authorization, incomplete eligibility check, or delayed payer follow-up can lead to: