Situation

As a trauma hospital that gets mostly stop-loss accounts, St. Francis needed a solution that would help them decrease denials, reduce discharge time and increase case management’s time with patients. Many of St. Francis’ denial challenges were related to claims denied due to lack of clinical information. With so many insurance companies needing clinical reviews, the staff at St. Francis needed to be sure the company responsible for authorization had the information necessary to approve all days of a patient’s stay.

In addition to that, if the Business Office found there was a piece of information missing, they had no way of accessing the information Case Management provided to the medical group. That meant they would have to track down the information or wait for Case Management to fax the documents again, which in some instances would delay payment at least 30 days.

Approach

St. Francis Medical Center was fighting the battle of lost information alone and it showed in their high rate of denials. With Vyne Medical’s Trace^® platform and utilizing its tools, there was no longer a fight. Information is stored in a centralized location, indexed by patient and may be accessible system wide.

By partnering with Vyne Medical and implementing Trace, St. Francis Medical Center saw first-hand what it was like to be armed with the tools that allowed them to save time and money. They now had the proof they needed to show that Case Management provided the correct information for authorization, resulting in a significant reduction in claims denied for lack of clinical information.

Results

One year after implementing Trace, St. Francis saw an 85% reduction in the amount of denials based on lack of clinical information – a difference of over $130K per month. Trace has helped St. Francis save a significant amount of denials each month and provided the Case Managers more time to focus on patients, payers and discharges.

Read the full case study about the benefits St. Francis Medical Center discovered utilizing Trace here.

Contact us to schedule a call with one of our Vyne Medical healthcare solution experts 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.