RECTIFI IN ACTION
Learn how you can use Rectifi to optimize healthcare claim denials in order to increase debt recovery for healthcare providers.
A prominent physician management company struggled with managing denials and appeals. Their current process led to a low collection rate of just 8.4%, resulting in a significant amount of unreviewed claims: a staggering $152 million.
An initial analysis revealed the company prioritized handling high-value claims for revenue recovery. This approach maximized their return on investment as reworking claims is a resource-intensive process. However, this strategy left a significant amount of potential revenue untapped from lower-value claims.*
As the healthcare revenue cycle becomes increasingly intricate, managing accounts receivable and resolving denied claims can be a growing challenge. Successfully recovering denied funds hinges on pinpointing the exact reasons behind them.
In essence, understanding why claims are denied is critical to getting them paid. In the realm of denials management, knowledge is power.
To tackle the denials challenge, the first step is understanding the specific claims most frequently denied. In the case of the physician management company, Rectifi's data engine revealed a surprising trend: 83% of denied claims were for emergency room (ER) visits, with a breakdown of high, moderate, and low complexity levels.
Digging deeper into the data, Rectifi identified a significant source of denials: missing or incorrect information. A staggering 88% of denials stemmed from coded errors like missing secondary insurance information or illegible entries. These codes (MA04, MA92, and MA130) all point to incomplete or inaccurate claim submissions.
Another culprit surfaced: The use of modifiers. Modifiers are codes that add details about a service provided. When used, the entire service can be denied.
This highlights the value of automation in flagging these errors before claims are resubmitted.
Recognizing the volume of denials was overwhelming existing resources, the client opted to pilot Rectifi's platform. Over a six-month period, the Rectifi engine analyzed 150,000 claims that would have otherwise gone unappealed. This demonstrates the platform's potential to significantly reduce denials and streamline the claims management process.
Denials due to administrative errors, unclear policies, or missing information can be a major headache for healthcare providers.
Rectifi's solution addressed these issues by implementing a "no-touch resubmit" system.
Automated technology reviews and corrects errors, allowing for automatic claim resubmission without manual intervention. This can significantly reduce the burden on staff and expedite the resolution of denied claims, ultimately decreasing administrative costs.
The impact of Rectifi's platform goes beyond streamlining processes. Here are some key results:
*The average administrative expense for revising a claim stands at a minimum of $25.00 in salary costs alone. Many claims may go through the process several times, compounding these expenses. The impact of the denied claims was substantial, underscoring the necessity of pinpointing their origins to address the outstanding unpaid balances effectively.
Your live demo includes how to:
• Unlock increased revenue with Rectifi's cutting-edge analytics
• Anticipate and Mitigate denials
to get paid faster
• Elevate your financial outcomes
through proactive decision-making
• Reduce friction and administrative burden within your organization
• Quickly understand and resubmit no-touch claims with the power of machine learning
Plus, it's personalized to your specific business needs, so you’ll see exactly how it can work for you. And you’ll get the opportunity to ask our team questions.
See the medical service of the procedure rendered that corresponds with the sample Billing Code
