Denial Reduction Triumph: FQHC's Path to Cash Flow Recovery

Nearly a year ago we received a call from a concerned CFO with a multi-location FQHC with over 25,000 active patients. Cash flow was reduced and was trending negatively for several months. The situation reached a tipping point during a pivotal Board Meeting when the treasurer questioned a troubling line item on the budget—the denials. The number appeared to be growing and thus impacting cash flow. This issue was already on the minds of the health center’s administrative team and one of the negatives on an otherwise very positive report. This issue had to be dealt with and fast.

Upon further review, this line item was a combination of several factors including billing errors, clinical coding mistakes, and provider enrollment issues. A plan of attack was created with the assistance of several members of the management team, tasks doled out and timelines established to quickly reduce the denials and increase much-needed cash flow. Of particular concern was the stubborn, long-lasting issue of provider enrollment. How to solve this persistent issue once and for all?

The organization's CFO took a deep dive into the issue and learned more than she bargained for in that the issue was multifaceted: new providers had joined the organization, one new clinic had been opened this year and the lingering repercussions of a poorly trained former staff member continued to haunt them. The previous staffer had moved on to another institution, leaving behind a legacy of issues. The replacement staff member was experienced in enrollment but at a medical practice. The question that echoed through the boardroom was how to untangle this web of issues, starting with the most substantial contributor to denials - new clinical location issues and provider enrollments. Enter PMG Credentialing…

During the initial kick-off call, the breadth of the provider and clinic enrollment issues were discussed and a short and long-term plan was created to tackle the problem. Multiple PMG Credentialing staff members were engaged to work on the issues and mitigate the losses. Our staff tackled the new clinic issue by connecting with payers, assessing the current status of the location, and initiating the proper paperwork. Remarkably, within a mere 20 days, they had all the necessary applications and supporting documents submitted - a feat that appeared Herculean in scale. Next on their formidable to-do list: providers.

PMG Credentialing’s experienced staff understand the unique requirements for new providers and their nuanced enrollment needs. A private practice is not a CHC and vice versa. Staff completed an assessment and began their plan of attack. This included contacting payers, concerning statuses with,tax IDs, and locations each provider practiced at among other items. A top-down approach was decided upon as is the norm: providers with the most denials were worked first then those with lower denials and less payer issues. Once again, a united, all-hands-on-deck effort ensued, and, understandably, this segment took a little more time, given the intricacies of coordinating with payers and external entities. The key to success in this phase? Unyielding persistence and follow-up.

The outcome was nothing short of astounding. In just one month, the denial line item saw an 84% reduction - a transformational achievement. What's more, the trend suggests that this improvement is set to continue in the coming months. The CHC has not only conquered its cash flow troubles but has begun to see the dawn of a budget surplus in recent months.

Witnessing this journey reminds us that even the most daunting challenges can be overcome with the right expertise and unwavering determination.

Contact us today to see how partnering with PMG Credentialing can impact your health center.

The situation reached a tipping point during a pivotal Board Meeting when the treasurer questioned a troubling line item on the budget—the denials. The number appeared to be growing and thus impacting cash flow.

Of particular concern was the stubborn, long-lasting issue of provider enrollment. How to solve this persistent issue once and for all?

The question that echoed through the boardroom was how to untangle this web of issues, starting with the most substantial contributor to denials - new clinical location issues and provider enrollments. Enter PMG Credentialing…

Multiple PMG Credentialing staff members were engaged to work on the issues and mitigate the losses. Our staff tackled the new clinic issue by connecting with payers, assessing the current status of the location, and initiating the proper paperwork.

PMG Credentialing’s experienced staff understand the unique requirements for new providers and their nuanced enrollment needs. A private practice is not a CHC and vice versa.

The outcome was nothing short of astounding. In just one month, the denial line item saw an 84% reduction -a transformational achievement. What's more, the trend suggests that this improvement is set to continue in the coming months.