Regional Health System Reduces Denials by 38%
Standardize prevention and recovery workflows across facilities and payer mixes to reduce avoidable denials.
Customer
Regional health system (12 hospitals)
A multi-facility provider organization with shared services supporting revenue cycle operations across inpatient and outpatient lines of business.
What changed
A consistent operating model across sites improved visibility, reduced rework, and prevented recurring denial patterns.
The Challenge
Denials were preventable, but the workflow wasn’t
- 1Variation in pre-bill edits and denial prevention steps across facilities created avoidable rework
- 2Manual identification and prioritization of denial risk made it hard to focus on the highest-impact fixes
- 3Limited closed-loop feedback from outcomes back into prevention playbooks and operational improvements
Solution
Standardize prevention and recovery with governance
Unified prevention workflows
Standardize denial prevention steps and reviewer actions across facilities with governed workflows.
Risk-based work queues
Route the right work to the right team based on impact, rationale, and operational priorities.
Operational feedback loops
Use outcomes to refine prevention rules and workflow updates, reducing recurrence over time.
Audit-ready governance
Maintain traceability of actions and standards appropriate for regulated healthcare environments.
Results
Measured outcomes on targeted categories
Results reflect the customer’s measured outcomes on targeted categories and workflows.
Want to reduce denials across facilities?
We’ll map your prevention and recovery workflows and show how to standardize them with appropriate controls.