Case Study: a mid-sized orthopaedic practice in KY reduces denials and boosts AR collections with Plutus Health

a mid-sized orthopaedic practice reduces denials 16% in 2 months with Plutus Health

The customer, a mid-sized orthopaedic practice in Kentucky, was facing a significant reduction in financial flow due to a high rate of claim denials and inappropriate coding, which caused an abrupt halt in payments and a major increase in outstanding accounts receivable (AR). To address these challenges, the practice engaged the vendor Plutus Health for its expertise in revenue cycle management and its proficiency with Nextgen billing software.

Plutus Health implemented a comprehensive solution that included a thorough analysis of the RCM process, identification of issues causing denials, and the use of automation for eligibility checks. The vendor's strategic measures resulted in a dramatic reduction of denials from 30% to 14% and rejections from 17% to 9% within just two months. Plutus Health successfully collected approximately $4 million through insurance AR efforts, achieving an 11% increase in revenue efficiency and maintaining average monthly collections of $350,000 for the client.