Hospitals across the country are challenged with interpreting payer rules and complex CMS guidelines. Misinterpretations can be costly when they impact patient classification (inpatient vs. observation), medical necessity denial rates, and an organization’s ability to overturn the denial concurrently.
Impact Advisors recently worked with a health system to determine why their revenue wasn’t improving alongside a slight increase in patient volumes. The team uncovered a higher-than-expected observation rate and a need to improve patient classification, create a stronger denial mitigation program, and redesign the physician peer-to-peer processes.
Here’s what our client had to say:
“Impact Advisors’ team worked with us side by side. They have walked in our shoes – their clinical knowledge was appreciated by our team and made it easier to work together and get results.”
-Chief Revenue Officer
The training, education, and onboarding delivered by Impact Advisors resulted in the capture of:
- Over $34M (annualized) in patient revenue due to patient classification improvements and denial reductions
- A 50% decrease in observation patients’ average length of stay (LOS)
- A 9% decrease in the overall system observation rate
Download the case study here.