Case Study
A/R Optimizer

Prospect Medical Benefits From 300-500 Fewer Denials Per Month With A/R Optimizer

woman smiling while attending a virtual meeting that's shown on her computer screen

Business issue

Prospect Medical grew very quickly from 10 to 17 hospitals and had many different patient accounting systems, billing systems and other vendor software products. To manage the strain of growth, Prospect sought solutions to enhance workflow and analytics, and to consolidate data across the organization.

icon-tech-computer-person-happy
Before FinThrive

Legacy systems failed to capture a comprehensive and accurate picture of claim denials

Denials not tied to contract management process

False positives, duplicate denials and secondary insurance issues

Lack of consistent reporting definitions and methodologies across facilities

icon-concepts-hands-growth
Solution Highlights

A true remaining balance using expected contractual amount and detecting denials

Payer scorecards to facilitate better negotiation with payers

Reimbursement analyzer to review what’s left at a line-item level

Underpayment and denials management

icon-buildings-hospital-3
Customer Overview

Prospect Medical Holdings is a significant provider of coordinated regional healthcare services in Southern California, Connecticut, New Jersey, Pennsylvania and Rhode Island

FinThrive Value

↓3.6%

Reduced inpatient denial rate from 17.2% to 13.6%

300-500

300-500 fewer denials per month for outpatients

$10M

One facility benefited from $10 million less denied dollars than the previous year

“In the past, if we had three or four out of ten denials that were false positives, the teams would lose focus on prevention efforts as they start assuming they’re going to see false positives that are not actionable. When we can identify real denials with real dollars at risk, there is an imperative and an energy to fix the underlying issues.”

Ryan Bayne
Corporate Vice President, Systems & Analytics

Confident business woman at easy

Revenue management without limits

FinThrive provides smarter, smoother revenue management to 3,250+ healthcare providers in North America, including 37 of the 40 largest hospitals and health systems in the U.S.