Success story: Glendive Medical Center

Emerging as a regional leader through A/R optimization

Situation and challenges

To its community in eastern Montana and western North Dakota, GMC is committed to being “your trusted partner in health.” GMC’s services include primary care; emergency access; physical, occupational, and speech therapy; radiology, respiratory, and laboratory services; and long-term care. Though today it’s a profitable and innovative 25-bed critical access hospital, its prognosis just a few years ago was uncertain.

In August 2015, GMC’s new CFO arrived and immediately faced an array of serious challenges: 

  • A new patient accounting system that was not yet working smoothly
  • A severely limited applicant pool for open positions in their business office
  • A loss of staff in their coding department 
  • AR days at 150+
  • Decreased cash
  • An ICD-10 implementation that needed to happen soon
  • Difficulty attracting and retaining skilled clinical staff in their rural location

Leadership had to act fast, to continue meeting their community commitments. They quickly laid out aggressive goals: 

  • Reduce AR days to 60 
  • Introduce new and expanded service lines for their community 
  • Become the region’s go-to destination for orthopedic services
  • Employ double coverage in all clinical areas 
  • Fine tune and optimize their new patient accounting system 
  • Implement ICD-10 within 60 days 
  • Identify a partner to help the revenue cycle team immediately increase cash flow and handle urgent initiatives (e.g., update chargemaster; reduce DNFB; provide documentation education for providers; provide ICD-10 education; address patient accounting system glitches; reduce denials and write-offs; and improve overall workflow)


In 2015, GMC leadership began taking decisive steps, contracting with Xtend to clean up the hospital’s AR with a day 60 cash acceleration and safety net project. In September 2016, they moved Xtend’s engagement to day 1 placements for all billing and accounts receivable follow-ups. Through close partnership with our customer, we have:

  • Cleaned up the aged accounts caused by the new patient system conversion
  • Implemented complete management of the accounts receivable billing and follow-up process 
  • Increased and sustained consistent monthly cash flow to support GMC’s leadership initiatives 
  • Reduced DNFB 
  • Provided coding support and audits, plus CDI education for providers 
  • Improved denial and appeal processes 
  • Built reports and analytics that track key performance data for long-term improvement strategies 
  • Improved workflow processes

“Xtend has exceeded our expectations. They were the first outsourcing company that Glendive has ever worked with. In addition to their expertise, we appreciate their level of professionalism, the fact that they are onsite frequently, their ability to deal quickly with our concerns, and their dedication to Glendive’s success.”

— Patient Financial Services Director, Glendive Medical Center


Today, thanks to this collaborative partnership, GMC has firmly established itself as one of the leading, most innovative hospitals in Montana. 

  • Net cash has increased by over 200%. Since our relationship began in 2015, total cash collected stands at over $120 million
  • AR days have decreased to less than 60, and AR over 90 days is now under 16%
  • GMC has opened a new urgent care clinic and a new behavioral health unit and brought on new providers, including two orthopedic surgeons. 
  • In 2018, GMC purchased a 3-D mammography system and was the first in Montana to offer this technology. 
  • GMC purchased a new robotic arm-assisted surgery unit from MAKO. 
  • In 2020, GMC constructed an addition to the facility to house a new 1.5T Phillips 16 Channel R5.4 MRI.