Rolling Hills Clinic
Rolling Hills is an Indian Health service clinic, similar to a Federally Qualified Health Center (FQHC), with four locations in Northern California. With 35 providers in a variety of specialties including primary care, dental, eye care, mental health and gynecology, among others, Rolling Hills serves the native and underserved population, performing 60,000 patient visits each year.
Community Clinics, such as Rolling Hills, and FQHCs depend on a reliable flow of funds to perform much needed services to their patients. As with any health care practice, cashflow is largely dependent on the accuracy and timeliness of billing. Improper billing practices, coding and submission errors can delay payment, while lack of follow-through on rejected claims makes funds uncollectible. Community Clinics and FQHCs with solid billing practices and processes for avoiding and promptly addressing rejected claims are successful at fulfilling on their mission to provide care for underserved populations. Furthermore, those with strong financial situations are able to expand care, add specialties, open new locations, and serve more of the people who need them most.
The Client's Need
Rolling Hills found itself in dire financial straits. Their billing practices, as guided by a previous billing partner, had led them to a collection rate of just 28% of what they should be collecting. It also negatively impacted their reporting and audits due to the inaccuracies in their AR. As the situation declined, leadership took a deep dive to learn that many claims were not processed and those that were being processed were not correct. Furthermore, they were set up with a clearinghouse that wasn’t meeting their needs, a challenge which disrupted cash flow for nearly ten months. Through the process, they ultimately uncovered 3,000 old claims totaling $1.5 million that could never be collected, resulting in significant lost revenue. The team quickly went to work to identify the easiest items they could bill and succeeded in bringing these funds in the door. They recognized, however, that this approach was not sustainable and that they needed help.
As the Rolling Hills team evaluated partners to support their revenue cycle management needs, a key requirement was knowledge and experience with eClinicalWorks®, as well as the ability to properly interface with the best clearinghouse for their practice. Knowledge of the unique needs and operations of FQHCs was also preferred. RCM360 and Ero Health quickly demonstrated expertise on all fronts. Because of RCM360’s strict focus on eClinicalWorks®, the team presented Rolling Hills with a dashboard, within a day, which provided valuable insights, and pinpointed where their challenges were so that a plan could be put in place to rectify them. RCM360 went to work on eClinicalWorks® setup, establishing proper billing practices and identifying the vast number of claims to be corrected, efficiently resubmitting to re-establish incoming cash flow for the practice.
A primary pain point for the practice resided in their dental specialty. Claims were not being processed, resulting in a seven-month backlog of claims to be submitted. The RCM360 team successfully worked these claims to expedite receipts and increase collections as quickly as possible. In addition, the clearinghouse that had been established was not set up properly for eClinicalWorks®. Eligibility was incorrect, which led to the inability to process claims. RCM360 successfully managed the transition to TriZetto, while concurrently managing the existing clearinghouse to ensure for a smooth and accurate switch.
Finally, Ero Health provided comprehensive eClinicalWorks® training for Rolling Hills providers, ensuring they had proficiency with the system and workflows.
The financial turnaround for Rolling Hills has been significant and swift. In the first four months of working with RCM360 and Ero Health, collections have increased from under $100,000 per month to $3 million per month. Net collection rates have soared from 60% to 100%, and days in AR have dropped from 240 to 50. Cash on hand has increased significantly as well. As a result of the training Ero Health has established, providers quickly gain proficiency in the system and are able to see patients at a full schedule within a day. This improvement in financial health has allowed Rolling Hills to add much-needed specialties to the clinics while enhancing the accessibility of care for the communities they serve.