Case study · FQHC network

A multi-site health center network's AR fell 20.7% from peak in four months. Here is where every dollar went.

Short answer: open insurance AR fell $1,104,607 from the June 30 peak, AR days 102.8 to 71.3, cash per month up 9.8 percent. The roll-forward closes within 0.25 percent, and 12.6 of the 31.5 days are fee-schedule arithmetic we do not claim.

Open AR · -20.7% AR days · 102.8 to 71.3 Cash per month · +9.8% Roll-forward · closes within 0.25%

October 27, 20266 min readASP-RCM Solutions

Archetype

FQHC network

Focus

AR turnaround

Metric

71.3 AR days

Horizon

4 months

Framework

Closes at 0.25%

Length

6 min read

-20.7%

Open insurance AR, net of credits, $5,326,118 on June 30 to $4,221,511 on September 30

ASP-RCM engagement records

71.3AR days

From 102.8 in May; 18.9 days genuine, 12.6 from the April fee-schedule increase

ASP-RCM engagement records

+9.8%

Cash per month, $1,089,570 before to $1,196,561 in the four ASP months

ASP-RCM engagement records

$881,307

Recovered from claims over 90 days old, June to September

ASP-RCM engagement records

The four months

Takeover to month end four, on one clock

A medical, dental and behavioral health network paid as Medicaid PPS encounters; its first 70 days are published separately.

1
May 2026102.8 daysBaseline, client formula
2
Jun 9TakeoverASP takes the full revenue cycle
3
Jun 30$5,326,118Open insurance AR peaks
4
Jul 31$4,999,0487-day posting hits 59%
5
Aug 31$4,506,651Largest monthly fall, 9.9%
6
Sep 30$4,221,511AR days 71.3
7
Oct 12$3.39MWeekly pack, not month end

Open insurance AR by month end

Down at every month end, $1,104,607 in total

Open insurance AR, net of credits, month end

Month ends only; the October 12 weekly pack ($3.39M) is another cadence.

$5,326,118peak, 100%

Jun 30peak

$4,999,048-6.1% vs Jun

Jul 31-$327,070

$4,506,651-9.9% vs Jul

Aug 31-$492,397

$4,221,511-6.3% vs Aug

Sep 30-20.7% vs peak

June 30 peakMonth end, net of creditsMonth end four

AR days, with the split disclosed

102.8 to 71.3: 18.9 days earned, 12.6 days arithmetic

Opening and closing AR daysImprovement we reportRate effect we disclose

DisclosureWe report 18.9 days, not 31.5. The April rate increase lowers AR days with no change in collections, so it is separated and published.

Cash

More per month, and more of it from old claims

Cash collected per month

Eight months before June 9, 2026 against four ASP months

$1,089,570

Before8-month average

$1,196,561

ASP monthsJun to Sep

+9.8% per month

Monthly cash on claims already 90+ days old

The line that matters in an aged PPS receivable

$190,169

Beforeper month

$220,327

ASP months$881,307 recovered

+15.9% per month

Cash velocity

Before and after June 9, measure by measure

Measure	Before	After	Change
Cash per business day	$47,838	$52,869	+10.5%
Median days to pay	41	34; June cohort 22	17% faster
Cash posted within 7 days of receipt	16% at takeover, median lag 15 days	31% in June, 59% in July	Posting speed sets the AR report
First-month dollars by service month	$444K to $588K	Flat, while the charge base doubled	r = -0.92

The committee's questionWhy did the first-month collection percentage fall while cash rose? The charge base doubled; dollars held at $444K to $588K. The denominator grew, not the lag.

The roll-forward

Where every dollar that left the receivable went

Dollars out of the receivable, June to September 2026

$7,616,461 left the receivable; the roll-forward closes within $10,605 (0.25%). Only the first segment is cash.

$4,555,484Cash · 60%

$2,076,528Contractual · 27%

9%Write-off

Cash collected$4,555,484 · 60%Collected

Contractual adjustments$2,076,528 · 27%PPS and fee-schedule differences

Uncollectible write-off$707,805 · 9%93% past timely filing at takeover

Credentialing adjustment$276,644 · 4%Practitioners not yet enrolled

Takeaway

Nine percent of the movement was write-off, 93% of it uncollectible before we arrived. A turnaround that hides its write-offs is not one.

What we did

Three changes behind the four months

Worked the credentialing hold weekly

Claims released as each enrollment cleared; the $276,644 adjustment is the part that could not be.

Posted cash within the week

Posting within 7 days went from 16% to 59% in two months; the AR report described the receivable, not a backlog.

Put aged claims on their own clock

A dedicated 90+ queue with a monthly cash target; $881,307 came back.

What is still open

Reported as measured, including what has not moved

SLA
Denial turnaround 41.36 days against a 5-day service levelFurthest from the contract; being rebuilt first.
90+
90+ share moved only from 52.8% to 49.58%New cash clears young claims first; the aged tail needs payer-by-payer calls.
CCR
Clean claim rate 95.51% in October against a 95% service levelNo pre-handover baseline; the client's own September figure was 93.32%. Not claimed.
835
Net collection and first-pass rates pendingPublished when the 835 and 277CA feeds allow.
-54%
AR behind open denials $1,424,386 to $655,508Lower at every month end; behavioral-health service levels still breaching. Separate page.

For other health centers

Three habits worth copying

Roll the receivable forward monthly

A falling AR number should be defensible line by line.

Restate AR days when the rate changes

Publish both figures; a rate increase lowers AR days on its own.

Track cash on 90+ claims separately

In a PPS book the aged tail holds the recoverable money: $881,307 here. See the FQHC KPI scorecard.

FAQ

Frequently asked questions

Why split the AR-days improvement into 18.9 and 12.6 days?

AR days divide the receivable by average daily charges, and an April fee-schedule increase raised the denominator with no change in collections. AR days fell from 102.8 to 71.3; we attribute 18.9 days to collections ($1,118,786 released at $59,195 a day) and 12.6 to the rate change, and publish both.

What is an AR roll-forward and why publish one?

It reconciles the opening receivable plus charges to the closing receivable through every dollar out: cash, contractual, write-off and other adjustments. Here it closed within $10,605, 0.25 percent, and showed 60 percent of the movement was cash and 9 percent write-off, 93 percent of that already past timely filing at takeover.

Cash rose 9.8% per month but AR fell 20.7%. Why the gap?

AR fell for four reasons: cash (60 percent of the movement), contractual adjustments, write-off of claims already uncollectible at takeover, and a credentialing adjustment for services billed under practitioners not yet enrolled. All four reduce the receivable; only the first is cash.

What has not improved yet?

Denial turnaround ran 41.36 days against a 5-day service level, AR over 90 days moved only from 52.8 to 49.58 percent, and net collection and first-pass rates are pending the remittance feeds. The October clean claim rate of 95.51 percent has no pre-handover baseline, so it is not claimed as an improvement.

Sources

Checked October 27, 2026. Client figures are from ASP-RCM engagement records for one organization and are reported as measured; rules change, so confirm regulatory sources before relying on them.

FQHC revenue cycle management FQHC billing services FQHC RCM toolkit The same network's first 70 days FQHC payment integrity: right rate, missing visits Behavioral health denial AR halved Credentialing hold $1.03M to $170K FQHC revenue cycle KPI scorecard

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