The Secret to Winning the Battle Against Claim Denials

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In a recent article, Rev Cycle Intelligence reported that in 2020 hospital claim denials were up by 23 percent. While the battle against denials has been going on for years (denial rates have been steadily rising since 2016), the events of 2020 surrounding the pandemic caused a sharp increase over the course of just a couple of months. Now more than ever, it’s essential for hospitals and health systems to have a sound strategy around lowering claim denials.

Winning the battle against denials requires objective proof of payer authorization and patient coverage. The Trace® platform from Vyne Medical offers tools to capture payer interaction by phone, fax or online. When a payer gives an authorization number or states that authorization is not required, Trace enables you to document the encounter and seamlessly tie it to the patient record. If the claim is later denied, you simply search by patient and produce the proof needed to stop the denial before it starts.

When Texas Health Resources implemented Trace as part of its denial reduction strategy, the health system was able to more effectively document insurance authorizations and recoup $2.5 million in overturned denials in a single year.

Similarly, Moffitt Cancer Center has experienced a significant reduction in denials as a result of using Trace. Over a four-year period, denied revenue dollars fell from 16 to 5 percent per month, and the average amount denied per patient encounter was reduced by $330.

Other client organizations have also leveraged the power of Trace to help improve their denials management programs:

  • Lowell General Hospital improved net reimbursement by nearly $3 million a year by reducing both inpatient notification denials and precertification denials with proof of patient authorization data
  • Health First prevented $900,000 in denials and overturned $400,000 for a return of more than $1.3 million in less than a year
  • St. Francis Medical Center reduced claim denials by 85 percent and drove $130,000 in savings each month
  • Community Health Network overturned $30 million in initial denials simply by documenting authorization, notification and level of care activities to verify patient coverage

For more than 20 years, Vyne Medical has armed hospitals with user-friendly, affordable solutions to win the fight against denials. We’d love to add your organization to the growing list of Trace denial management success stories. Contact us to schedule a call with one of our Vyne Medical healthcare solution experts today.

 

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