--- title: "How we put $3,190,000 of new billing revenue in front of a revenue cycle management firm in six months. | Stone Haven Capital Group" description: "22 multi-site specialty groups signed, at an average of $145,000 a year each. Six months. A medical billing and revenue cycle firm. No conference booths, no association sponsorships, no waiting on referrals from the practices they already served." canonical: "https://stonehaven.capital/showcase/medical-billing-rcm" last-updated: "2026-08-22" --- > 22 multi-site specialty groups signed, at an average of $145,000 a year each. Six months. A medical billing and revenue cycle firm. No conference booths, no association sponsorships, no waiting on referrals from the practices they already served. Stone Haven Capital Group Schedule a Call Case study · Medical Billing & RCM # How we put $3,190,000 of new billing revenue in front of a revenue cycle management firm in six months. 22 multi-site specialty groups signed, at an average of $145,000 a year each. Six months. A medical billing and revenue cycle firm. No conference booths, no association sponsorships, no waiting on referrals from the practices they already served. - $3,190,000 generated in 6 months, from 22 multi-site specialty groups at an average of $145,000. - 567,412 emails to 141,853 companies, producing 1,134 replies at 0.8%. - 250 interested conversations became 85 held meetings and 22 signed groups. - What did most of the work: we kept every cold email off the domain the client's existing practices already know. - What went wrong: we put a calendar link in the sequence far too early. 01 ## Did they get a good result? They did, and the figures are here unpolished. Growth before us came from word of mouth inside two specialties and a handful of consultant referrals, which had produced $1,139,000 of new annual billing revenue over the previous six months. The same six months with outbound running produced $3,190,000, which is 2.8 times the baseline, and it came from groups nobody in the firm had ever met. What happenedThe number New annual billing revenue signed in six months$3,190,000 Multi-site specialty groups closed22 Average annual value per group$145,000 Growth against the prior six months2.8x on a $1,139,000 baseline Qualified conversations85, carrying $10,030,000 Interested replies logged250, carrying $20,483,000 Emails sent567,412 Practice groups contacted141,853 Replies1,134, a 0.8% reply rate Bounce rate2.1% across 11,916 bounces Six months in the sending platform. 02 ## Did you get them in front of the right people? Reach is the easy half. A billing contract gets signed by an administrator, a CFO or a revenue cycle director who already has a vendor and a switching cost, so the only meaningful test is whether the conversations landed on people with the authority to end an existing contract. 250 interested replies were logged against $20,483,000 of possible annual billing value. 85 of those survived a qualification call, carrying $10,030,000, which is 34.0% of the interested set. 22 signed, worth $3,190,000 a year at an average of $145,000 per group. The conversion is where the targeting shows. 1,134 replies produced 250 interested ones at 22.0%, and better than a quarter of the qualified conversations closed inside the engagement. A list aimed at the wrong seniority does not hold that shape at the back end. It produces replies and then stalls. The pipeline as the practice groups moved through it. 03 ## What worked, and why ### We kept every cold email off the domain the client's existing practices already know. A billing firm sends claim correspondence, remittance queries and payer appeals from its own domain all day. Putting cold volume on that domain risks the mail that keeps the existing book of business running. So none of it went there. We stood up 143 sending domains carrying 430 inboxes, authenticated on SPF, DKIM, DMARC and MX before anything went out, all 430 in continuous warmup, capped at 20 sends per inbox per day. Across the programme the estate carried 567,412 sends, finished at a 2.1% bounce rate on 11,916 bounces, and held 92.0% inbox placement with zero accounts in an error state and 7 alerts raised and cleared. The sending estate, authenticated end to end and separate from the client's domain. The reason that holds: the domain carrying every payer and practice relationship never took a single cold send, and the estate that did was built to be replaced. ### We built the list around groups large enough to have a denial problem worth outsourcing. Below roughly eight providers a group usually keeps billing in house and the arithmetic on a percentage of collections does not clear. Above about sixty it has a director of revenue cycle, an internal team and a procurement process that outbound does not shortcut. The list was cut to multi-site specialty groups inside that band, at administrator, CFO and revenue cycle director level. What came out mattered as much as what stayed. Single-site practices, hospital-owned groups, anything already inside a health system's central billing office, and specialties whose payer mix makes the offer uneconomic were all removed before a word of copy was written. That left 141,853 groups contacted across six months. The reason that holds: practice size tells you whether the economics work. Site count and specialty tell you whether the denial volume is painful enough for anyone to take the call. We answered every interested reply the same day and measured meetings that finished rather than meetings that got booked. An administrator who replies at nine in the morning is comparing vendors by lunchtime. Replies were worked inside the same working day, and the booking record was reconciled weekly against what actually took place. That reconciliation is the reason the qualified figure is 85 rather than something larger. Meetings that were booked and then cancelled were removed from the count instead of being carried forward as pipeline, so the number the client saw each week was the number of conversations that had genuinely happened. Created against completed, with the cancellations beside them. That gap is the number this market lives on. The reason that holds: a booking is a promise and a completed meeting is a fact. Reporting the promise makes a programme look faster than it is and hides the exact failure that kills these engagements in month three. We ran a four-touch cadence on uneven waits and opened with the shortest email in the sequence. Four touches with four, six and nine day gaps, three variations on the opener and three on each follow-up, all running against each other from launch. The opener is deliberately small: a bare first name with no greeting word, a single observation, a request for permission to send something, and initials at the bottom. It reads as though a person typed it between two other things, which is the only register that survives an administrator's inbox at eight in the morning. The winning opener: a name, one line, and a request to send something over. The reason that holds: uneven gaps stop the sequence reading as automation, and an opener short enough to finish in four seconds gets finished. Length is a cost the reader pays before they know whether the message is worth anything. ### We reviewed angles weekly against the conversations that completed. Every week the angles were judged on qualified conversations rather than reply volume. An angle that produced replies from office managers with no vendor authority was switched off even while its reply count looked healthy. Six months is roughly twenty-four reviews, which is enough to be ruthless without thrashing. A single thread, from cold email to a request for the breakdown. 04 ## The five angles we test, in every market There is no way to know in advance which framing a market answers. The market decides, and the only honest method is to ask it five ways at once and read what comes back. These five hold up across sectors because they are built on how a purchase decision gets made rather than on what is being sold. 05 ## 1. Pain led State the constraint they live with in the words they would use, then ask whether it is true at their end. Strongest where the problem is well known in the category and nobody wants to say it out loud first. Most administrators we talk to are writing off denials nobody has the hours to appeal. Is that where you are as well? 06 ## 2. The benchmark Show them where they sit against comparable organisations. Almost nobody knows their own percentile and almost everybody wants to. We pulled first-pass acceptance across specialty groups your size in the same payer mix. Want to see where yours lands? 07 ## 3. Risk reversal Move the risk to your side of the table. Carries the most weight in markets where the reader has already been let down by a vendor doing the same job. We are paid on what we collect, so if collections do not move you have paid us nothing. Worth a look? 08 ## 4. The soft ask Lower the bar until agreeing costs them nothing. No call and no commitment, only permission to send something over. Would a short read on where the denials are concentrating be useful? Happy to send it across with no call attached. 09 ## 5. The teardown Offer to look at something of theirs and say what is wrong with it. Specific, slightly uncomfortable, and hard to ignore because the reader wants to know what you found. Had a look at how your claims are coming through on two payers and there is a pattern worth flagging. Want the two lines? 10 ## How we use them All five go out together across a split list from day one. Within a few weeks the reply data has named the one or two this market wants, and the rest are switched off before they consume any more of the addressable pool. Which one wins is unpredictable. That one or two will win is not, and running five at once is what turns that from a bet into an expectation. The same five port to LinkedIn with shorter wording and the same underlying framing. 11 ## What did not work, and what we did about it Three things went wrong. They are here because you will meet at least one of them on your own engagement. ### We put a calendar link in the sequence far too early. The link went out on the second touch, on the theory that removing a step removes friction. It removed the wrong friction. The week filled with office managers and billing supervisors who found the offer genuinely interesting and had no authority whatsoever to end a contract with an existing vendor. Meeting volume rose and every other measure of quality fell with it. The first pull, before any authority or exclusion filtering was applied. What we changed: the link came out of the sequence entirely and a qualification exchange went in front of it. The list was rebuilt at the same time, from 379,374 contacts on title and headcount alone down to 164,945 with authority signals and hard exclusions applied. The same market once the authority filter and the exclusions went on. ### We left tracking switched on for the first three weeks. A tracked email carries a remote image request that fires when the message renders. Filtering systems read that request as a marketing signal, and the sender pays for it in placement. Over the first three weeks the estate's bounce rate ran ahead of where it settled and placement testing showed a share of the newer domains landing outside the primary inbox on the two largest consumer-adjacent providers. Nothing in the campaign copy explained it, and the domains were correctly authenticated. What we changed: tracking was removed from every campaign in week four and the estate has sent plain text with no remote assets since. Bounce rate settled at 2.1% and placement came back to 92.0%. The programme is measured on replies, qualified conversations and signed groups, all of which are visible without instrumenting the email at all. ### We called an A/B test on a sample far too small to read. Two opener variants were compared inside a single specialty segment after a few hundred sends each. One looked clearly ahead, so it was kept and the other was switched off. The gap was inside the range that random variation produces at that volume, which means the decision carried no information. We had removed a variant for no reason and told ourselves we had learned something. What we changed: variants now stay live until each has accumulated enough sends and enough replies for the difference to mean anything, and anything below that threshold is reported as undecided. Undecided is an acceptable answer. A confident answer built on noise is not. No programme of this length runs clean, and a case study without a section like this one has had it deleted. The corrections are the part that carries over to your engagement. 12 ## Why this works for revenue cycle management specifically Billing firms tend to grow through the same two channels: referrals from consultants and practices, and whoever a group happens to meet at a specialty association event. Both work and neither can be turned up. The pipeline arrives when it arrives, and nobody can tell the owner what next quarter looks like. Three features of this market make outbound unusually effective: - The buying unit is small and named. A billing decision sits with an administrator, a CFO or a revenue cycle director at a group you can identify in advance by provider count, site count and specialty. There is no committee to find. - The pricing model does the selling. Payment as a percentage of collections means the first email is not asking anyone to commit budget. That removes the objection that ends most cold conversations before they start. - Contract value justifies the volume. At $145,000 of average annual billing revenue per group, a handful of signed conversations pays for the entire programme, and the remainder is margin. 13 ## Why would this work for your business? ### Possibly it will not. The table sorts that out faster than a call does. This works ifThis does not work if Your clients are organisations you can identify in advance by size, type and locationYour buyers only surface through personal introductions and cannot be listed One signed client is worth five figures a year or moreA signed client is worth a few thousand dollars once The addressable market runs to tens of thousands of organisationsThere are four hundred possible buyers and you already know all of them The person who signs holds a job title you can nameThe decision is made by a committee that assembles only after a referral You can absorb a meaningful increase in qualified conversationsNobody on your side can work a reply the day it arrives Reading down the left column means the method transfers, and nothing about this client was unusual. A billing firm with a real service, satisfied clients and no mechanism for reaching groups outside its referral radius. What produced the result was process, and the process does not change for you. 14 ## One more thing worth understanding The number worth watching in this market is the cancellation rate on booked meetings. Booking rate on its own tells you almost nothing. An administrator books a call the way they clear an email. It costs them nothing at the moment they do it, and the meeting sits a week out against a schedule that fills with payer escalations and staffing problems. A programme reporting bookings can look excellent for a month while a third of the calendar quietly evaporates, and nobody notices until the qualified count fails to move. Cancellation rate is a quality measure wearing a scheduling costume. It rises when the sequence is reaching people who have no authority, when the offer was oversold to get the yes, or when the gap between booking and meeting is long enough for the interest to cool. All three are fixable, and all three are invisible if you only count bookings. So this programme reported completed meetings from week one and treated a cancellation as a signal about the list rather than as an administrative annoyance. That is why the qualified number here is smaller than a booking count would have been, and why 22 of the 85 turned into signed groups. 15 ## Before and after Before After six months New annual billing revenue in a six month window$1,139,000 $3,190,000 Where new groups came fromReferrals and specialty association events 141,853 groups contacted directly Cold sending infrastructureThe firm's own domain 143 domains, 430 inboxes, none of it on the client's domain Qualified conversations in the periodNot tracked separately from referrals 85, carrying $10,030,000 Inbox placementNot measured 92.0% 16 ## If you want to know whether your market has this in it The first call is short. Describe the groups you want as clients and what one is worth to you across a year of collections. We come back with how many of those groups are actually reachable, what conversation volume is realistic against that pool, and whether outbound is the right instrument here at all. If we think it is not, you will hear that on the call. Finding out now costs both of us a quarter of an hour. ## Want to know whether your market has this in it? The first conversation is short. You tell us who your buyers are and what one is worth to you. We tell you how many we can actually reach, what the meeting volume looks like, and whether outbound is the right lever for you at all. If we think it is not, we will say so. 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