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Revenue Optimization and Staff Augmentation for a Major Health System

Challenges

Our client, a major university health system, was looking to optimize revenue. They had millions of dollars on hold as the claims hit the clearing house due to improper coding, POS and modifier issues, demographic mismatch, and more. Providers may have given illegible medical reports which prevented the coders from coding with highest specificity. Unavailability of experienced staff created a backlog which caused revenue leakage. Clearing the denials within the TFL was another challenge due to the shortage of expert coders.

Solution

Vee Healthtek's expert team worked on the charts and gathered the areas where provider education was required. We assisted the client on revenue enhancement, if properly documented, by coding with the highest specificity. Working on clearing the claim edits based on the CMS, NCCI and LCD/NCD guidelines helped the maximum number of accounts go out the door. Our denial experts reviewed the EOB of denied claims and provided the appropriate coding decision which helped the timely resubmission of claims.

Vee Healthtek provided sufficient experienced staff to the client to clear the backlog.

Results

Appropriate action taken on clearing the claim edits and denials helped to drop the huge backlog. This resulted in additional revenue recovery. Coding to the highest level of specificity helped increase the payments in ED accounts.

Vee Healthtek followed compliant and transparent process to achieve our client's goal.