Welcome to TRACE by The White Stone Group, Inc.

Proof Points

TRACE Used to Recover $57K Sacred Heart Medical Center $57,039.69

Communication Event: FaxCert
Challenge: Denial for lack of notification
Benefit: Recovery of $57,039.69

The admitting office used FaxCert to capture a fax with notification to a payer. The faxed notification included a roster of admitted patients. The payer denied the claim, citing lack of notification. The hospital located the fax record, along with a date and time stamp showing the timeframe of notification. The hospital sent the record to the payer, and the claim was paid. The hospital recovered $57,039.69.

PixCert Proves Online Authorization Froedtert Memorial Lutheran Hospital $7,157.52

Communication Event: PixCert
Challenge: Denial for lack of authorization
Benefit: Recovery of $7,157.52

The Admitting department used TRACE to capture online authorization obtained from a payer's web site. The claim was processed and denied by the payer for lack of authorization. The hospital used the TRACE electronic record to prove the patient's authorization. The claim was overturned, and the hospital recovered $7,157.52 of the original denial for $11,343.11.

$43K Recovered at Children's Hospital Children's Hospital in Tennessee $43,269.69

Communication Event: Fax
Challenge: Denial for Lack of Authorization
Benefit: Recovery of $43,269.69

A utilization management coordinator initiated a FaxCert to fax a clinical review to an insurance company.

The claim was processed, and payment was denied for lack of authorization. The coordinator used TRACE to locate the original fax and resend it to the payer, along with confirmation of the date and time it was originally sent to the insurance company.

After reviewing TRACE documentation showing the date and time of the original fax, the payer overturned the denial and reprocessed the claim for payment.

TRACE Proves Correct Reference Number King's Daughters Medical Center, Ashland Hospital Corp $78,210.55

Communication Event: VoiCert
Challenge: Denial for Invalid Reference Number
Benefit: Recovery of $78,210.55

The Case Management department used TRACE to record a call to request inpatient precertification for a patient. The payer provided a reference number. The claim was processed and denied for an invalid reference number. The hospital used the TRACE call record to prove that the department used the reference number provided by the payer. The denial was overturned, and the hospital recovered $78,210.55 of the original denial for $193,977.00.

Proof of authorization at Owensboro Medical Health System Owensboro Medical Health System $1,951.91

Communication Event: VoiCert
Challenge: Denial for lack of preauthorization
Benefit: Recovery of $1,951.91

A case manager used TRACE for a call to obtain precert for an observation stay following an elective planned surgery for loss of vision. The payer was secondary to Medicare. The payer representative stated that precert was not required for inpatient observation after a planned outpatient surgery. The claim was processed and later denied for lack of preauthorization, citing no precert obtained for observation stay. The case manager located the call recording in Tracker and provided a transcript as proof of the payer’s instructions. The denial was overturned, and the payer paid $1,951.91 of the $11,135.69 claim as its percentage secondary to Medicare.

Case Studies in Adobe PDF format

West Jefferson	Texas Health System
Children’s Hospitals

Videos

	The Proof You Need Anne Tanner Director of Case Management City of Hope
	A Safety Net of Proof Dawn Worcester Supervisor PAS WellStar
	Decreased Denials Rita Bowen Director HIM/PO Erlanger Health System
	Overturning and Preventing Denials Darlene Gondrella Director, Case Management West Jefferson Medical Center

Articles in Adobe PDF format

Health Data Management - Feet to the Fire	"Leverage communication to protect your revenue" - Healthcare Finance News
Secure payment, increase productivity and enhance quality	TRACE Times – Current Issue

Quotes

• "We have used TRACE to overturn more than $2 million in denied claims and prevent an estimated $4 million in denials. As a result, our denials for eligibility and precertification issues are now at .03 percent."
  
  - Florence Davis, Director of Patient Access, Children’s Healthcare of Atlanta (GA)
• "TRACE gives us an accurate and indisputable record of communication for evidence in overturning denials. We have experienced a total payback of nearly $1 million and a four-year history of decreased percentages in days denied with TRACE."
  
  - Britt Tabor, Chief Financial Officer, Erlanger Health System (TN)
• "We wanted something that would be simple, user-friendly and provide a strong return on investment. We got our return on investment within the first four months of operation."
  
  - Angela Greener, Chief Administrative Officer, West Jefferson Medical Center

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