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