Urology Associates of Central California
Central California (Fresno area) Proposed Management: nCare (MSO) + HEMI (Automation + Data Layer)
Practice Snapshot
Physicians
5 Owners, 2 Employed
APPs
2 tenured, 3 newer
Region
Central California
Scope of Care
Strategic Context
Strategic Position
- High clinical volume, especially in clinic-based visits and oncology follow-ups
- Complex payer and IPA environment (including IPAs such as Sante, Amada, Meritage)
- Revenue heavily influenced by In-Office Dispensing (IOD) for advanced prostate/bladder cancer drugs
- Revenue also driven by high-complexity procedures
Current Pressure Points
- Operational overload across staff and physicians
- Fragmented revenue cycle workflows
- Contracting/credentialing risk and reporting gaps
Historical Ancillaries (Divested/Closed)
Sold after sustained financial underperformance and underinvestment
Current State: Two physicians retain minority ownership; operational and financial control is now with an external (ophthalmology-focused) entity
The ASC is no longer part of UACC's direct revenue cycle for professional practice billing
Closed due to regulatory complexity (CLIA) and billing challenges (UA and histology modifiers)
Current State: Pathology is no longer managed as a separate in-house entity
Former in-house lab that handled histology and related tests
Organization & Roles
Physician Team
7- Two senior physicians are in their eighties and gradually reducing responsibilities (especially call)
- One younger partner has passed away, which impacts call coverage and clinical workload
- Limited bandwidth for physicians to participate deeply in operational projects
- Call burden is concentrated among a smaller subset of physicians
Advanced Practice Providers (APPs)
52 long-tenured (~20 years at the practice), 3 newer (including 2 relatively recent graduates)
Responsibilities
- Run independent clinics focused on routine follow-ups, UTIs, and lower-acuity complaints
- Handle catheter changes and bladder instillations
- Support oncology and procedural workflows as needed
- Participate in hospital / weekend coverage in conjunction with physicians
Non-Clinical Departments
Front Office / Patient Access
- New patient coordinator
- Referral indexing staff
- Check-in and scheduling team
Eligibility & Prior Authorization
- Two internal eligibility staff handling high-volume eligibility checks
- External vendor (Advantum) assisting with prior authorizations
Coding & Charge Capture
- Two internal coders with specialty experience
- External coding support from PRS Network for volume/backlog control
Accounts Receivable (AR) & Denials
- Internal AR staff
- Two outsourced AR resources (company name TBD)
Contracting & Credentialing
- Contracting historically managed by a long-time specialist (now retired)
- Credentialing currently handled by external consultant
Diagnostics / Imaging
- Radiology / imaging operations integrated into clinic (urodynamics, CT, X-ray)
Oncology / In-Office Dispensing
- Patient navigator role linked to PPS Analytics and drug programs
Service Lines & Revenue Streams
Technology & Systems
Workflows by Domain
Detailed documentation of how each operational domain works today.
Revenue Cycle Operating Model
| Function | Internal Team | External Vendor | Risk Level | Notes |
|---|---|---|---|---|
| Eligibility | 2 in-house staff (high volume checks) | Advantum | High | Historically full turnover; fragile team |
| Prior Authorization | Some handled in-house | Advantum manages a large portion | Medium | Performance and oversight are concerns |
| Coding & Charge Capture | 2 experienced coders | PRS Network supports volume/backlog | Low | Current state: charges near-current |
| AR & Denial Management | Internal AR staff | 2 AR resources from external vendor | High | Hard to track per-user productivity |
| Contracting | No dedicated internal FTE post-retirement | Critical | Contracts not centrally structured today | |
| Credentialing | Oversight by practice manager (limited) | External credentialing consultant | Critical | Recent serious Medicare issue |
| Reporting & Analytics | Ad-hoc use of EHR/analytics and manual Excel | High | No unified KPI framework currently |
Reporting & KPIs – Current State
Historical Reporting
Previously received quarterly KPI reports from a management firm (relationship ended)
Current Reality
- Allscripts analytics module is powerful but underused due to complexity
- Phreesia and PPS Analytics provide local views into check-in, patient responsibility, and payment behavior
- PPS Analytics provides oncology cohort identification
Missing Dashboard Metrics
No single, unified dashboard currently shows:
Result
Leadership and the practice manager lack quick, reliable visibility into overall revenue performance and bottlenecks
Pain Points & Constraints
Stable themes identified across discovery conversations.
Staff Overload
Front office, eligibility, AR, and physicians all describe feeling at or beyond capacity
Manual, Fragmented Processes
Referrals, eligibility, PA, and AR work rely heavily on manual steps and spreadsheets
Fragile Staffing in Key Functions
Eligibility team turnover; AR stability issues due to leaves/performance; dependence on specific individuals historically (contracting specialist)
Limited Visibility and Reporting
No consistent KPI or dashboard culture in place now. Difficult to know what is actually working.
Contracting & Credentialing Risk
No central contract inventory. Recent Medicare credentialing disruption underscores risk.
Referral Backlog & Access Risk
Three-week referral backlog can delay access and potentially lose patients
Charge Lag and Documentation Variability
Uneven note completion across providers leads to lag between service and billing
Physician Bandwidth Constraints
Limited ability for physicians to invest time in operational projects and change management
Engagement Fit Summary
nCare FitsMSO
- Taking structured ownership of revenue cycle operations
- Stabilizing eligibility, PA, AR, and denial workflows
- Supporting contracting and credentialing clean-up
HEMI FitsAutomation
- Providing claim-level visibility via Claim Catalyst and Navi
- Enabling better dashboards and KPI tracking
- Longer-term: cohort and care-management flows for oncology populations
Data Gaps & Open Questions
Data & Artifacts to Attach
Categories for future KB expansion:
- Provider roster and APP roster
- Org chart (administrative and clinical)
- Current payer/IPA list
- Contract and fee schedule inventory (when available)
- Example AR aging reports
- Denial summary reports
- Sample Phreesia and PPS Analytics outputs
- Policies for documentation and note closure
- Prior authorization SOPs
- Credentialing tracker
Missing Information (To Collect)
To mature this KB, the following gaps need to be filled:
- Exact clearinghouse and claim submission details
- Detailed payer mix (by percentage)
- Current days in AR
- Denial rate and top categories
- Charge lag averages
- Collection rate by payer
- Detailed org chart with named leads for each department
- List of all external vendors with point of contact and contract terms