Case Studies

Valuable & Educational Resources for Healthcare Professionals

Case Study: Unappealable Denials

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Unappealable Denials: How to Review & Determine the Most Difficult Cases Our client, a large four-hospital system, was facing a difficult challenge: THE CLIENT EXPERIENCED A SIGNIFICANT RISE IN WHAT THEY DEEMED UNAPPEALABLE PAYER DENIALS. As a result, they continued to face the following challenges: – An imbalanced their revenue cycle denial budget – Difficulty managing increased write-offs – Trouble determining whether accounts were truly unappealable This issue is particularly problematic as payers continually deny rightful payment when cases are not appealed, and the payer decision is not challenged. This directly impacts hospital revenue and is important in renewing the contractual relationship with the payer. Our team of clinical appeals specialists, analysts and educators worked together to develop a system-wide solution for the client. Download the case study and contact us to learn more about denials management services.