CASE STUDY

BACKGROUND

This FQHC is a very large non-hospital based ambulatory care provider. As a FQHC, it serves predominantly uninsured or medically underserved populations, and its mission is to provide quality, community-based, affordable, accessible primary health care services in a culturally sensitive manner with respect and dignity.

CHALLENGES

The complex payer environment faced by a FQHC leads to a multiplication in reimbursement types, claim formatting, and other program requirements. It’s not unexpected that such complexity resulted in high denial rates. The large volume of Wrap, Letter of Agreement (LOA) and Grant policy claims increased the pressure on overall Days in AR, often inflating the AR greater than 90 days.

SOLUTION

The FQHC brought ABW Medical on board, and ABW began improvements by cleaning up Hold buckets. The team then rapidly moved to developing many new business processes to address the mix of capitation payments and other payers. For example, this included creating custom transaction codes to handle certain LOA adjustments. The combined team created a dashboard of key performance indicators (KPI) and together reviews it weekly. If there are anomalies, the account team runs analytics reports to help identify the root cause for further process review and workflow improvement.

RESULTS & BENEFITS

• RRR – increased from 73% to 93%
• Backend Denials – reduced from 45% to 25%
• Days in AR (DAR) – decreased from 87 to 64 days
• AR>90 – reduced from 47% of overall AR to 39%

ABW has helped more than 5,000 providers across 45 states through its mission to create more revenue, time and peace of mind for providers, staff, owners and patients.