Compliance Success Story: Preventing $500K in Denied Claims
- Compliance Gaps Drive Denials: A multi-specialty clinic faced a 15.2% denial rate and over $520K in annual revenue loss due to documentation, coding, and authorization errors.
- Data-Driven Compliance Audit: Reviewing 3,000 denied claims exposed root causes across payer rules, coding accuracy, authorization workflows, and filing timelines.
- Targeted Staff Training Works: Updated CPT/ICD training, payer-specific rules, and standardized checklists improved coding accuracy from 89% to 97% and reduced authorization errors by 42%.
- Automation Prevents Errors Early: Pre-submission claim checks caught missing data, incorrect codes, and payer-specific rules, boosting first-pass acceptance from 84% to 96%.
- Continuous Monitoring Reduces Risk: Monthly denial dashboards and quarterly training lowered denial rates to 5.8%—a 62% reduction within one year.
- $500K+ Revenue Recovered: Faster payments, fewer reworked claims, and 70% less staff rework time delivered over $500,000 in recovered revenue without increasing patient volume.
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- Compliance Gaps Drive Denials: A multi-specialty clinic faced a 15.2% denial rate and over $520K in annual revenue loss due to documentation, coding, and authorization errors.
- Data-Driven Compliance Audit: Reviewing 3,000 denied claims exposed root causes across payer rules, coding accuracy, authorization workflows, and filing timelines.
- Targeted Staff Training Works: Updated CPT/ICD training, payer-specific rules, and standardized checklists improved coding accuracy from 89% to 97% and reduced authorization errors by 42%.
- Automation Prevents Errors Early: Pre-submission claim checks caught missing data, incorrect codes, and payer-specific rules, boosting first-pass acceptance from 84% to 96%.
- Continuous Monitoring Reduces Risk: Monthly denial dashboards and quarterly training lowered denial rates to 5.8%—a 62% reduction within one year.
- $500K+ Revenue Recovered: Faster payments, fewer reworked claims, and 70% less staff rework time delivered over $500,000 in recovered revenue without increasing patient volume.