An Urgent care center decreased its denied claims from 20% to 1% in just 6 months

The Client

• The client is a Texas-based 20-year-old Urgent Care facility

The Problem

• The client was facing challenges in their claim collections
• Their Billing and claim submission process had undiscovered gaps hurting their bottom line

The Process

To optimize the claim submission process and increase claim collections, Plutus Health started the project in July 2021. During the process:

1. Our team uncovered the gaps inhibiting the optimal claim submissions, which delayed collections building up to AR days of 140+.
2. We found 2500+ pending unsigned claims from the past year, which were unbilled yet.
3. We worked rigorously to file these pending bills within the Timely Filing Limit.
4. We got most claims cleared within six months and surpassed our client's expectations to revive them from their low collection phase.

Achievement

Dec 2021 was the month with the highest Revenue in 20 Years of the client's history.

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Results

Our client experienced these positive results across the three most important KPIs within the first six months

1. Denials – We brought down Average Monthly claim Denials from 20% to 1% in 6 months.
2. AR Days–Significantly reduced AR days from 143 to 63 within 6 months.
3. FPPR – Increased the First Pass Resolution Rate for the client from 80% to a whopping 98%.

About Plutus Health

Plutus Health provides Urgent Care focused Revenue Cycle Management Services. We help Urgent Care clinics increase collections and reduce denials, emphasizing compliance.