Health clinic improves claims efficiency to grow practice and boost revenue

Equality Health operates three clinics across Phoenix, Arizona and prioritizes making high-quality care accessible to the communities it serves — regardless of patients’ race, ethnicity, age, or income. As a value-based care organization, a key to their success is removing barriers to good health by offering multiple services at each location, which helps close care gaps and treat the patient holistically. But continued growth presented Equality Health with its own barriers — including tackling a mounting backlog of accounts receivable items while consistently submitting claims and adding new services for patients.

Equality’s biller was stretched thin supporting seven physicians across three locations. “Our old A/R had ballooned out of control – it was becoming overwhelming for our biller to work denials and drop claims on a daily basis,” said Hector Reyes, Director of Clinic Operations. They considered adding another biller but increasing fixed costs and requiring an already strained staff to take on the hiring and training process didn’t seem like the best approach.

Hector realized that Equality needed a solution they could implement quickly and one that was minimally disruptive. For them, going live with athenaOne Enhanced Claim Resolution™ was fast and seamless. “The process was really easy for us to get onboarded and live,” said Reyes. “Communication with the athenahealth team was great, and expectation-setting was thorough.” Within the first three months of using Enhanced Claim Resolution, Equality Health reduced the average number of days claims were in accounts receivable in client holds from 106 to just three. They also reduced the average amount of outstanding accounts receivable from $1.5 million to about $450,000. Ongoing support from athenahealth to work the more time-consuming and complex claims, and denials, has also impacted their income, said Reyes. “Our net revenue skyrocketed – from 2020 to 2021 alone, we’ve seen an increase of 40 percent in net income.”

Now, with an improved cadence in the speed and consistency of claims going out the door and significantly fewer denials to work, daily tasks are more manageable for their biller — even with Equality’s continued growth. Using Enhanced Claim Resolution has freed up valuable time for the practice to add new services to help close gaps while patients are in the clinic. One added service is on-site retinal camera scanning, which saves patients a lot of time and hassle, increasing the likelihood that patients don’t abandon treatment.

Previously, patients would have to schedule another appointment to see the ophthalmologist, get scanned, and Equality Health would wait for results before claims could be submitted to payers. “Now, that procedure takes 15 minutes and the patient is taken care of,” said Reyes. “Without Enhanced Claim Resolution I wouldn’t have the time or the personnel to do that unless I hire someone else – so that made a world of difference for us, keeping us growing for the future.”

Without Enhanced Claim Resolution, I wouldn’t have the time or the personnel [to add a service] unless I hire someone else – so that made a world of difference for us, keeping us growing for the future.

Hector Reyes, Equality Health director of clinic operations