Reconfigure underpayment and denials workflow to recover dollars

Mission Health System, 7 facilities, Asheville, NC

Over the past four years, Mission Health has employed multiple different staffing setups to best address the fluctuating volumes and pressures caused by underpayments and denials.

However, because the organization lacked a robust reporting platform to track payer performance or vital payer payment trends, it was severely limited in its ability to accurately calculate expected reimbursement based on payer contracts, view line-item denials, and understand the size of front-end billing issues; there was no single system to generate worklists for both contractual underpayments and denials.

Using Payment Integrity Compass, the Advisory Board team worked with Mission to configure a workflow for its team across both underpayments and denials, ultimately resulting in $110M in total underpayment and denial recoveries.