Successfully Overturning Denials Begins with Establishing Proof of Patient Authorization

Case Studies, Denials

Moffitt Cancer Center is dedicated to partnering with patients and their families to provide a quality experience. With this mission in mind, the center recognized a need to redesign front-end workflows to improve operational efficiency, financial integrity and patient experience. Moffitt turned to Vyne Medical and the Trace® platform to support the effort.

Authorization Process

As part of the redesign, Moffitt’s Financial Clearance Unit began overseeing the center’s denials management strategy. Already having experience using Trace, the team quickly adapted to managing authorizations.

Authorizations are obtained in one of two ways: phone or website. The Financial Clearance Unit documents these authorizations with Trace call recording and screen capture applications and then links the documentation to the patient record.

Denial Reduction

Trace provides teams with structure to quickly and easily access the proof they need to overturn denials. With Moffitt Cancer Center’s authorization process in place, the Financial Clearance Unit knew where to go for proof to reverse their denied claims.

When a claim is denied, coordinators can easily access proof of authorization by searching Trace for the patient, date of service or any other search criteria. Once found, the recording and/or image can be sent to the payer to overturn the denial and obtain accurate reimbursement for the claim.

Results

Improving front-end workflows with the power of Trace has helped Moffitt Cancer Center reduce the percentage of denied revenue dollars by month from 16 percent in 2015 to 5 percent in 2019.

Percentage of Denied Revenue Dollars by Month

As the volume of denied claims steadily declined, so did the average amount denied per patient encounter, which decreased from $763 in 2016 to $433 in 2019.

Average Dollars Denied per Patient Encounter

For more information on how Vyne Medical is helping organizations win the battle against denials, click here.

Learn how Vyne can help your organization with denial management. Schedule a call with a Vyne Medical representative today.

 

 

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Any case studies, testimonials, examples, and illustrations included originate from customer statements as general experiences, which are intended for informational purposes with no guarantee of users achieving similar results.