Welcome to TRACE by The White Stone Group, Inc.

Proof Points

Proof of notification for appropriate level of care New Jersey hospital $7,200.00

Communication Event: VoiCert
Challenge: Denial for level of care requested
Benefit: Recovery of $7,200.00

A patient access representative used TRACE to record a call placed to notify a payer of a maternity admission with delivery. The call included notification of the newborn’s admission to the special care nursery. The payer responded with authorization for the mother and advised the hospital to call the next day for an ID and authorization for the newborn’s admission. When the hospital called the following day, the payer confirmed that the baby’s authorization was on file and provided an authorization number for the baby’s admission. On both calls, the patient access representative stated that the baby was admitted to the special care unit. When the claim was processed, the insurance company denied the claim for the level of care requested, stating that the hospital did not provide notification that the baby was admitted to the special care unit. The hospital located both call records through TRACE and sent the records as proof that notification was provided for the appropriate level of care. The payer overturned the denial, and the hospital recovered the $7,200 claim.

New Jersey hospital recoups $1600 for endoscopy New Jersey Hospital $1,598.00

Communication Event: Trace Voice
Challenge: Billing dispute
Benefit: Recovery of $1,600

A Patient Access representative used Trace to record a call to a payer to inquire if precert was needed for an outpatient endoscopy procedure. The payer responded that no precert was required. When the claim was processed, the payer denied the claim for lack of precert. The hospital used the Trace voice record to verify that the payer stated that no precert required. The payer overturned the denial and reimbursed the hospital $1,598.00.

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.

TRACE Saves Nearly $60K Texas Hospital $59,125.69

Communication Event: VoiCert
Challenge: Denial due to lack of clinical information
Benefit: Recovery of $59,125.69

A hospital called and provided clinical information to a payer. The payer responded that clinical was only needed upon request.

The claim was later denied due to lack of clinical information.

The hospital was able to retrieve the phone call from TRACE proving the payer’s receipt of the clinical information. The payer agreed to pay the claim.

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.

Case Studies in Adobe PDF format

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

Videos

	Near Misses Allison Thomason CM Manager WellStar
	Overturning and Preventing Denials Darlene Gondrella Director, Case Management West Jefferson Medical Center
	Overturning Denials Lisa Hixson Patient Access Manager Sacred Heart Medical Center & Children's Hospital
	Achieving ROI with Trace Michelle Fox Director of Patient Access Health First, Inc.

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

Contact Us