Community Health Case Study
Community Health Case Study
Community Health Case Study
Community Health Center Clears $412K in Aged A/R Without Disruption
Executive Summary
A multi-location community health center had more than $900,000 tied up in aging receivables, most of it stuck past 90 days. Claims had been submitted. Encounters were documented. But the payments weren’t coming through.
Scionis RCM was brought in to work the backlog and identify breakdowns in billing practices. Within 12 weeks, the team recovered $412,000 in aged claims, cut Medicaid denials by 37%, and reduced unnecessary write-offs by 22%. The improvement didn’t require new systems. It required direct action, tight follow-through, and communication with internal staff.
The Problem: Aged Claims, Incomplete Follow-Up, and No Systematic Recovery Process
The health center’s reports showed the problem clearly:
- A high volume of claims sitting past 90 and 120 days
- Denials were rarely revisited after the first rejection
- Front-desk workflows lacked consistency
- The billing team was overwhelmed and under-supported
- Aging claims were regularly being written off
The facility served a wide payer mix, Medicaid, Medicare, commercial, and uninsured, each with its own billing rules. But the billing team had no structured way to handle denials or track timely filing windows. Prior efforts to clean up old claims with outside vendors failed due to lack of understanding of community health billing and Medicaid logic.
Key Issues Identified
- Eligibility errors: Front-desk staff were missing COB updates and secondary payers. Claims were sent with incorrect or incomplete coverage data.
- Missing documentation: Claims were missing modifiers, service details, or complete visit notes. This resulted in avoidable denials.
- No assigned ownership: Once denied, many claims were not followed up. Rebilling efforts were sporadic and lacked direction.
Outsourced teams lacked payer knowledge: Previous vendors treated the backlog like generic commercial A/R. Medicaid-specific errors weren’t addressed.
Scionis RCM’s Approach
Scionis RCM assigned a recovery team with specific experience in FQHC billing and Medicaid denial resolution. The work focused on execution, not planning.
1. Detailed Claim Sorting
Claims were broken down by payer, aging group, and denial reason. Each line item was assessed for recovery potential based on timely filing limits and clinical documentation.
2. Priority-Based Recovery
High-dollar and near-expiration claims were handled first. Denials were corrected based on the exact issue cited by payers. No mass rebilling. No shortcuts.
3. Process-Level Corrections
Same Medicaid claims getting kicked back for missing eligibility. We didn’t just fix them ourselves. We pulled in front-desk and billing staff, showed them where things were breaking, and helped tighten up their intake steps so the same mistakes didn’t keep happening.
4. Weekly Reporting and Tracking
Progress was reported weekly with clear documentation: claims touched, dollars recovered, denials overturned, and open issues that needed client input.
Results After 12 Weeks
- $412,000 in aged A/R recovered
- 37% reduction in Medicaid-related denials
- 22% drop in preventable write-offs
- A/R >120 days decreased from 46% to 19%
The center did not change its system or platform. The results came from applying consistent recovery effort, payer-specific knowledge, and structured accountability across internal teams.
Why the Engagement Worked
- The recovery team had direct experience with FQHC billing
- Denials were handled with case-by-case corrections, not bulk resubmissions
- Root causes were documented and discussed with staff as they came up
- Client operations continued without disruption
This cleanup engagement allowed the health center to recover revenue that would have otherwise been written off. With aging claims under control, the internal team was able to refocus on current-cycle billing.
Scionis RCM continues to support FQHCs and community health networks with targeted A/R recovery and denial resolution strategies that reduce write-offs and strengthen internal billing operations.
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