Client Overview:
Our client is a high-volume healthcare provider that experienced significant revenue losses due to issues with Workers’ Comp and No-Fault claims. The in-house billing staff struggled to maintain strong follow-ups on denials and failed to file timely appeals.
Challenge
The healthcare provider faced multiple challenges:
- Persistent revenue losses due to denied Workers’ Comp and No-Fault claims
- Inefficient follow-ups on denials
- Delayed or incomplete appeals filing
- Lack of proper tracking and documentation for claims progress
Solution
To address the revenue recovery issue, we implemented a comprehensive and strategic approach:
Compliance with NY State Laws:
We thoroughly reviewed and adhered to all applicable NY state laws and regulations governing Workers’ Comp and No-Fault claims. This ensured that appeals and claims submissions were compliant and had a higher chance of approval.
Drafting Comprehensive Appeals:
Our expert team drafted detailed and compelling appeals for all outstanding claims. These appeals included the necessary supporting documentation to strengthen the case for payment recovery.
Proactive Follow-Up:
Dedicated billers conducted follow-up calls for each claim, meticulously documenting interactions and tracking progress. This ensured that no claim was overlooked and that payers were consistently engaged until resolution.
Detailed Documentation:
We maintained thorough records of all claims activities, including follow-up communications, appeal submissions, and claim status updates. This enabled transparent reporting and accountability.
Results
Our efforts yielded impressive outcomes:
- Payments were successfully collected for claims that were over 1 and 2 years old
- Significant recovery of lost revenue
- Enhanced claim management processes for the client, ensuring future sustainability.
Logs of our continuous follow up
Another e.g. of dedicated follow up logs
Payment collected for a year old claim
Payment collected for a year old claim