The Case

Our client, a large, five-hospital system was facing a difficult problem:

47% PERCENT OF THEIR CLAIMS WERE BEING BILLED FOR INCORRECTLY DUE TO INACCURATE PATIENT STATUS ASSIGNMENTS.

As a result, they encountered subsequent issues leading to a decrease in revenue:

  • A significant increase in concurrent denials
  • Increased retrospective claim denials
  • Noncompliance with Utilization Review regulations
  • Wasted time and monetary resources in the process of billing inaccurately

Our team of Clinical Appeals specialists, analysts and educators worked together to develop a system-wide solution for the client. The results were impressive:

  • Reduced strain on client team due to process improvements and education
  • Positive change in accuracy rate from 53% to 86%
  • 16% reduction in overall denials
  • Correct concurrent patient status assignments
  • Immediate positive effect on billing compliance as the quality of claims were improved

Download this free case study to learn how Managed Resources combats concurrent utilization review denials to improve compliance and prevent future denials.

About Managed Resources

Managed Resources specializes in essential services such as medical coding support, revenue cycle management, medical billing and coding review, and many other managed healthcare solutions.

Since 1994, Managed Resources has partnered with organizations ranging from large health systems, tertiary and community hospitals, and renowned physician groups, providing leadership and expertise across their revenue cycle operations.

Representing the best talent in the industry, our experienced team is uniquely qualified to assist healthcare organizations in meeting their operations goals. Click to learn more about our proven solutions.