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Case Studies
Case Study: Denials Recovery Uncovers $40 Million in One Year
A large, multi-department hospital with more than $1 billion in net patient revenue and over 34,000 discharges annually was having difficulty managing denials and appeals volume. The hospital’s in-house Denials Management team believed certain DRGs were not worth appealing and downgraded them at the time of denial. Download our case study to learn more and enhance your revenue cycle strategy.
A large, multi-department hospital with more than $1 billion in net patient revenue and over 34,000 discharges annually was having difficulty managing denials and appeals volume. The hospital’s in-house denials management team believed certain DRGs were not worth appealing and downgraded them at time of denial.
Seeking a better way to utilize internal resources and recognizing they could not keep up with the volume of denials, the hospital agreed to pilot Cloudmed Denials Recovery. Cloudmed evaluated 25 cases, which would have been closed by the hospital without appeal, and recovered $293,000. Given the success of the pilot program, Cloudmed became the hospital’s sole denials management vendor. Collaboration on process improvement initiatives with payers and denial identification has eased the burden on staff. Creation of constant feedback loops from Cloudmed to the client team has resulted in improved appeal turnaround timeframes and payer accountability, as well as highlighted areas for denials prevention and clinical feedback.
In the first year, Cloudmed was referred 9,234 cases and recovered $40 million in revenue. By partnering with Cloudmed, the hospital has maximized recoveries and now appeals 100% of denials.
Related Resources
How a Top Cancer Center Recovered 74% of Cash from Denials
Don’t let denied claims hold you back from providing the best care possible to your patients. Download our case study now and discover how Cloudmed can help you recover more of your revenue, so you can focus on what really matters – the health and well-being of your patients.
Best Practices to Combat Denials
Effective appeals are a critical component of any denial management program. This session will offer best practices to combat denials plus offers some simple tools from our lawyer’s toolbox.
Take Control of Clinical Denials
On-demand webinar. Take Control of Clinical Denials: Expert tips on prevention and appeals management
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