Financial Success
Below are "Proof Points" from TRACE customers who have used the power of proof to achieve financial success for their hospitals. See the following examples to learn the benefits of tracking all communication events with TRACE.
Proof Points
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.
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.
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.
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.
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.
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