Lowering General Surgery Denials Below Benchmark

Audit Findings: A 6-week review of 600 claims showed 80% of denials came from front-end issues like eligibility, prior authorization, coding errors, and missing documentation.
Front-End Fixes: Real-time eligibility checks and mandatory authorization fields reduced the largest denial category (35%).
Coding Controls: Daily coder reviews and automated edits helped prevent ICD, modifier, and laterality errors before claims were submitted.
Documentation Gate: Claims were blocked until signed operative notes were uploaded, eliminating documentation-related denials.
Payer Rules Automation: A payer rules engine ensured correct POS codes, modifiers, and submission requirements, reducing payer rejections.
Results: Denials dropped from 12% to 4.1% in 120 days, improving collections speed and overall revenue cycle performance.

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Audit Findings: A 6-week review of 600 claims showed 80% of denials came from front-end issues like eligibility, prior authorization, coding errors, and missing documentation.
Front-End Fixes: Real-time eligibility checks and mandatory authorization fields reduced the largest denial category (35%).
Coding Controls: Daily coder reviews and automated edits helped prevent ICD, modifier, and laterality errors before claims were submitted.
Documentation Gate: Claims were blocked until signed operative notes were uploaded, eliminating documentation-related denials.
Payer Rules Automation: A payer rules engine ensured correct POS codes, modifiers, and submission requirements, reducing payer rejections.
Results: Denials dropped from 12% to 4.1% in 120 days, improving collections speed and overall revenue cycle performance.