El Milagro Clinic is a single-site, non-profit health center that provides access to primary care, behavioral health, women’s health care, and wraparound services to the Rio Grande Valley (TX) community, regardless of their capacity to pay. PCDC worked with El Milagro Clinic to identify which exchange plans El Milagro Clinic is contracted with, discuss billing best practices, and increase an understanding of current credentialing pathways.

PCDC conducted an audit of exchange payers and facilitated conversations between the practice management team and Athena (an EHR and practice management platform). During coaching sessions, KPIs were discussed in detail and collectively the team was able to quantify payer write-offs due to credentialing, contracting, and a few other issues.

Through conversations with the Athena representative, we were able to identify a path for El Milagro to access Athena’s knowledgebase and to identify solutions related to timely filing write-offs, bulk updating claims, and KPI reporting. Moving forward, El Milagro will meet quarterly with their Athena representative to discuss collections year over year, AR by claim status, AR by payer, inflow, and schedule density & management.

Marisol Resendez, Executive Director of El Milagro had this to say after the engagement, “PCDC helped us reconnect with insurers. We were able to retrieve reports from our EHR system that we did not know were accessible and will now continue to monitor. PCDC’s guidance and support was just as invaluable when communicating with insurance carriers, which in our experience, had been very challenging. The changes and new processes established during this project have benefited the clinic and will absolutely continue to positively impact our financials. Because we serve mainly uninsured individuals and families, we didn’t realize the dollar amount we were leaving behind or had prioritized this and important this process. Thanks to PCDC we are now able to timely submit claims for payment to insurance carriers while continuing in our mission of serving the uninsured.”