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January 11, 2023

Discover how mental health organization reduced its 90+ AR below 5% in just 3 months

by Plutus Health
Coding Quality of Nephrology Practice Reached 98%Download PDF

The Client

The client is a large-sized mental health service organization spread across multiple locations in the US.

The Problem

  • The client faced challenges with its 90+ AR. These AR reached 23% and were rising continuously.
  • The client had a massive backlog of about $8M in payment posting.

Plutus Health Plan of Action

We started working for this organization in March 2021 for two of their locations. To begin with, we conducted an AR audit and analyzed the RCM strategy for the client to understand their workflow. In this process, we identified the following issues:

  • Absence of proper patient eligibility verification process.
  • Gaps in the patient's medical records.
  • Tons of non-posted payments.

Our team implemented a robust process to ensure eligibility and benefits check 3 to 5 days before appointments. We optimized the eligibility process and reduced patients' medical record gaps.

We did RCA (Root Cause Analysis) and bifurcated payments: payer-wise, $ value wise, and other priority categories and started the posting activity.

We consolidated all the backlog payments to understand the non-posted payments pattern.

We worked on the denials by implementing a proper denial management process.

The Results 

Plutus Health Inc.The Results

  • Posted all legacy payments and resolved legacy claims.
  • Reduced the 90+ AR below 5% within just three months.
  • Started AR follow-up with 52 days and maintained AR days by 28 days.
  • Increased payment inflow by 70% within 90 days.
  • The backlog payments of ~$8M got posted in less than 30 days.

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