RevenueHealth Case Study: Southwest Federally Qualified Health Center

The Challenge

A large Federally Qualified Health Center (FQHC) in the Southwest was concerned about their lack of visibility into claim denials and overall claims activity. This is a common story in the industry; according to a survey conducted at HIMSS19 (https://www.himss.org), less than 24% of healthcare executives leverage their data daily.

The FQHC’s chief financial officer was concerned that cash collections were not matching clinic productivity rates, and the director of revenue cycle didn’t have the data she needed to show him why. Furthermore, due to the difficulty of pulling mean- ingful data from their complicated billing system, the health center couldn’t make informed decisions around important challenges such as reducing claim denials.

After evaluating several vendors, the FQHC chose to partner with RevenueHealth. The key factors in their decision included our:

  • In-depth understanding of and experience in billing and revenue cycle management (RCM) operations
  • Focus on FQHC/community health center challenges associated with PPS/FFS billing models and complex Medicaid managed care landscapes
  • Ability and commitment to customize our system to account for the intricacies of their practice and state

The Solution

The health center decided to implement RevenueHealth’s intelligent denial workflow tool (DMS), our powerful denial source analytics engine (ERA360) and scanned paper conver- sion service that converts paper remittances (EOBs) into electronic remittance files (ERAs). Using these solutions, the health center was able to:

  • Isolate thousands of non-actionable claims from problem Medicaid Managed Care payers so they could clearly focus on their actionable Additionally they were able to quickly and easily compile data around those claims used to negotiate mass appeals with those payers
  • Implement automated processes for tracking and managing denied claims, ensuring that no claim fell through the cracks
  • Create targeted process for working claims, improving staff efficiency and morale

“We have already realized various efficiencies and are working smarter, not harder.”  – FQHC CFO

The Results

Fulfilling one of the client’s key priorities, RevenueHealth has given the FQHC access to data that they didn’t have before. The health center can now quickly identify signifi- cant payer issues (especially from Medicaid managed care) and create targeted action plans for addressing those issues. In addition, we’ve provided insight into their huge volumes of billing data, which has allowed them to make better-informed business and process decisions.

The subsequent improvements in the management and productivity of the client’s billing workforce produced tangible results like these over the first eight months:

  • A 7% increase in the average payment collected per visit, which has the potential to increase annual revenue by millions of dollars
  • An 8% drop in the claim denials rate, signaling a major improvement in operational efficiency
  • A decrease of over 50% in the volume of paper EOBs
  • A tangible increase in identified actionable claims, reducing the claims that might fall through the cracks and increasing overall biller productivity; a decrease in re-denial rates; and more reliable cash-collections trends

“With a fresh set of eyes and tools, we’ve been able to identify opportunities to enhance our structure and processes,” said the client’s CFO. “We have already realized various efficiencies and are working smarter, not harder.” These improvements have allowed the health center to focus on their mission of delivering exceptional and accessible patient-centered healthcare.

RevenueHealth is proud of this FQHC’s progress and results to date, but we’re in it for the long term. Through regular meetings and responsive customer service, we’re learning alongside the client to help them serve their patients better and boost their bottom line.

About Us

RevenueHealth’s cloud-based suite of medical billing denial management software solutions automates the capture, analysis and prioritization of complex claim and remittance data (configurable at the client level). As a result, your organization can finally have access to the data needed to succeed. The members of our leadership team have an average of over 30 years’ experience in the medical billing and RCM space.  We offer multi-specialty support and have partnered with over 3,000 providers to manage more than 10 million claims.