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Proof Points

TRACE for Observation Status Memorial Hermann Northwest $584.22

Communication Event: VoiCert
Challenge: Denial for lack of authorization
Benefit: $584.22

A patient access representative at Memorial Hermann Northwest used TRACE to record a call to obtain authorization for an observation stay. The payer responded by stating that observation does not require authorization. The payer later denied the claim for lack of authorization. The hospital submitted a transcript of the call record with an appeal. The denial was overturned, and the hospital recovered $584.22 of the claim for $1,751.75.

New Jersey hospital proves no precert required New Jersey Hospital $811.00

Communication Event: Trace Voice
Challenge: Denial for lack of precert
Benefit: Recovery of $800

A Patient Access representative used Trace to record a call to a payer to request precert for an outpatient diagnostic procedure. The payer verified patient benefits, stating that the procedure was covered 100% for an in-network hospital, with no copay or deductible. The payer also stated that no precert was required for the procedure. The claim was later processed and denied for lack of precert. The hospital used a transcript of the Trace call record to verify that the hospital was told no precert was required. The payer overturned the denial, and the hospital recovered $811.00.

Arizona Hospital Recovers $260K Arizona Hospital $260,068.00

Communication Event: VoiCert
Challenge: Denial for 8-day inpatient surgery
Benefit: Recovery of $260,068.00

A payer denied coverage for an 8-day inpatient surgery, claiming that the hospital did not provide a referral or obtain authorization for the initial consult and work-up, which included expensive diagnostic testing. From a clinical perspective, the hospital had to proceed with timely surgery in order to avoid detriment to the patient’s well-being.

The patient access department used TRACE to locate the call recording, including confirmation of the payer’s authorization for the initial consult and work-up and references to the specific CPT codes. When the department offered to send a transcript of the call, the payer came through with authorization for all services.

Without proof of the authorization, the hospital would have had to write off $260,068 in fees for the consult, work-up, surgery and hospital stay.

TRACE proves auth for observation stay Memorial Hermann Southeast $13,084.25

Communication Event: VoiCert
Challenge: Denial for auth not matching billed service
Benefit: Recovery of $13,084.25

A patient access representative in the business office used TRACE to record a call placed to obtain benefits for a 23-hour observation stay. The payer responded by issuing authorization for a 23-hour observation visit and advised the hospital to call back if the patient’s status changed to inpatient. The claim was processed and denied on the basis of authorization not matching billed services. The hospital located the TRACE call record and submitted the proof with the appeal. The denial was overturned, and the claim was paid. As a result, Memorial Hermann recovered $13,084.25 of the $21,612 claim.

$16K Recovered at City of Hope City of Hope Cancer Center $16,812.83

Communication Event: VoiCert
Challenge: Denied for Lack of Clinical Data
Benefit: Recovery of $16,812.83

A patient was admitted to the City of Hope Cancer Center. The physician dictated a history and physical for only the first day of the patient’s stay. On the second day, further testing led the physician to write orders for a specific diet.

The hospital requested 24 hours to make sure the patient responded well to the treatment. The payer approved the request but later denied the claim, citing “lack of clinical data.”

The case manager used TRACE to locate the VoiCert record of the payer’s approval, as well as the supporting clinical data including X-rays, labs and notes. The payer overturned the denial in one day, and the hospital recovered $16,812.83 in charges.

Case Studies in Adobe PDF format

Zimmerman Features TRACE as Revenue Cycle Best Practice	West Jefferson
Texas Health System	Children’s Hospitals

Videos

	Achieving ROI with Trace Michelle Fox Director of Patient Access Health First, Inc.
	Near Misses Allison Thomason CM Manager WellStar
	Decreased Denials Rita Bowen Director HIM/PO Erlanger Health System
	Overturning Denials Lisa Hixson Patient Access Manager Sacred Heart Medical Center & Children's Hospital

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."
  
  - 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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