Case Study
Targeted Intervention Reduces Denials for Large Southeast Health System
- Customer: Large health system in the Southeast
- Challenge: Reduce denial rate and improve workflows
Results
- 25% reduction in primary denial rate
- 2.5% reduction in overall hospital billing (HB) denial rate
- 275,000 fewer denials annually
- $50,000 – $100,000 A/R reduction per month
Tegria was a great partner for our Denials Improvement Project. They were able to come in and help us put together plans around a lot of our top denials, then build and test those updates in the system so our IT teams could focus on other pressing needs. In a year, we were able to drop our primary denial rate by over 25%.
EXECUTIVE DIRECTOR OF REVENUE CYCLE
Background and Challenge
One of the country’s largest healthcare providers recognized the need to reduce its denial rate. While the primary goal was denial reduction, there were additional concerns with the volume of denials falling into work queues that required no end-user intervention, inflating queue volume. In summary, the organization was experiencing:
- High primary denial rates.
- Elevated overall HB denial rates.
- Inflated work queue volumes for items requiring no end-user intervention.
Solution
Tegria leveraged its denials expertise to assess and address these denial challenges. The approach included:
1. Targeted Analysis: Investigating specific denial categories to uncover root causes.
2. Collaborative Approach: Working closely with operational and IT teams.
3. System Optimization: Implementing Epic system enhancements to prevent denials and automate follow-ups.
Results
This large health system successfully reduced its denial rate through targeted interventions and expert guidance, surpassing industry benchmarks. This accomplishment has led to significant improvements in both administrative workloads and cash flow. The significant result serves as a model for healthcare organizations that seek to optimize their financial operations and enhance patient care by improving revenue cycle processes.