Case Study
Accounts Receivables – Denials

Client Profile
A large, well known billing company based in California.

To analyze and reduce major denials faced by in-house denial teams.

Our Business Process Improvement (BPI) team through best practice methodology, did the following:

The Approach

  • To study the commonly occurring denials from month to month.
  • To study the insurance-wise denials.
  • To provide solution matrix by focusing on the major denials reported through Pareto analysis on 3 months denial reports.

The Solution
Our BPI team took the following initiatives to improve collections and to increase the productivity of the agents by focusing on the major denials:

  • Analyzed 3 months of denials data through a root cause analysis method, observed, and studied an agent's step-by-step work on a demo of the process.
  • Our AR experts then studied, compared, and analyzed the denial and error occurrences of their own demo work vs. that of an AR agent on the floor, including type and frequency of gaps and understanding of the process.
  • Our BPI team then initiated a recommended corrective plan with our in-house training team, which resulted in a drastic reduction in major denials.
  • The percentage of denials on Eligibility criteria showed a significant drop, the month after this exercise was done.

The Results
The success of this best practice methodology benefited our client in the following manner:

  • Reduction in denials
  • Improved revenue
  • Decreased backlog of denials
  • Timely collections

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