How Plutus Health Reduced Legacy AR by $2M and Achieved 97%+ NCR for a $200M ABA Network 

Client Profile

Specialty: ABA Services

Location: USA

Size: Over 3,500 providers and 4,000 clients

Annual Revenue: $200M+  

This case study shows how a $200M ABA provider reduced legacy AR and denial rates while achieving 97%+ collections through a clean, structured RCM rebuild.

The Challenges:

A large national ABA provider was growing fast but struggling to manage a fragmented and inefficient RCM operation.

• Limited visibility into billing performance from their prior vendor
• Delayed claims follow-up and 4+ month payment lags
• Denial rates consistently exceeding 10%
• Credentialing mismatches and group NPI billing errors
• Preventable denials due to missing documentation and incorrect setup
• Inactive coverage services due to lack of eligibility checks  

Plutus Health Plan of Action:

Data was collected from various sources, including financial records, billing data, and patient information. The data collection methods included:

• Reviewing historical claim data.
• Analyzing billing, payments, and AR data.
• Conducting interviews with staff involved in the RCM process.

Issues Detected:  

• Incorrect billing under group NPI for a specific payer, despite requirements for individual NPI - resulted in ~$4.5M in under collections
• Delayed payments due to medical records audits, with missing documentation (treatment plans, session notes, etc.) led to ~$500K in delayed collections and payer audit flag
• Credentialing mismatches for two practice locations, causing denial of all associated claims — ~$1.5M in revenue impact
• Lack of standardized billing procedures, leading to session time errors and duplicate denials post-submission
• No structured eligibility verification, resulting in services rendered for patients with inactive coverage
• Authorization-related denials across multiple payers due to missing or mismatched auth details during transmission