How AGS Coding Denial Management Helped Minimize Denial Write-Offs.
Even the most efficient healthcare organizations commonly see payers delay and deny claims for patient services. Resolving these denials is an ongoing struggle. Without clarity on why a claim was denied or the expertise to pursue appropriate payment, hospitals end up writing off large amounts of much-needed revenue.
Health System Situation
One of the largest academic medical centers in the northeast commissioned AGS Health to provide coding denial management services. With inventory building, they needed a partner that could scale quickly and identify the root cause of the problem.
AGS ramped up quickly and put in place measures to understand the cause of coding denials. After rapidly uncovering the issues, AGS identified 70 front-end coding fixes, with a net revenue impact of $4 million dollars. AGS closely partnered with the health system and made pragmatic, actionable recommendations on creating modifications within their practice-management system to include:
- The review of frequently denied CPTs for possible modifier appendage
- Non-specific/non-covered diagnosis based on CMS guidelines
- Max-benefits/unit-based rules
AGS was able to achieve a 72% decrease in the health systems denial inventory within 6 months and achieved net collections of $1.4 million on balance of $2.7 million dollars. Additionally the health system achieved a 40% cost savings from outsourcing coding denial management to AGS.
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