An OBGYN Provider Generated $245k+ from Old AR and Denied Claims in 3 months

Client:

Mid-sized OBGYN provider based in Illinois.  

Challenges Faced

• Claim rejection at the clearinghouse 
• Claims were stuck in open balance or unsettled account 
• Their AR buckets were rising  

Plutus Health's Plan of Action

Our team prepared a detailed strategy to streamline clients' RCM processes. 

• We started with a thorough analysis of their RCM process which uncovered existing gaps.
• Our team identified the reason behind major denials with our advanced denial and rejection analysis tool.
• Our denial management specialists identified analyzed the denial pattern. 
• We worked on all the issues to deliver promising results.

Issues Detected

• BCBS claims got denied for "Taxonomy codes missing on the claim form"
• BCBS claims denied stating, "Not enrolled with the payer"
• Contracts with insurance got terminated
• Credentialing and non-participating issues led to a significant loss in reimbursement 
• Payment posting was out of TAT
• Untimely AR follow up 

Plutus Health Solution

• We guided the client in enrolling backdated and resubmitted claims.  
• Professionals from our team helped the client with TAT and posted all the payments.
• Plutus Health's highly experienced billers fixed the practice management billing system to remove the missing code issues.
• Our credentialing expert helped the client with backdated credentialing to reduce AR.
• Denial management specialists from Plutus Health addressed all the denied claims in 48 to 72 hours.

Achievement

The client achieved uninterrupted cash flow in just three months of working with us.

• Generated revenue of over $245K from AR & denied claims. 
• Brought down the AR days to minimum and denial rates below 5%