Case Study: Denials Recovery Uncovers $40M in One Year
Discover how a large, multi-department hospital recovered $40M+ in a single year by modernizing its denials management approach.
With $1B+ in net patient revenue and 34,000+ annual discharges, the organization faced rising denials and appeals volume, but limited internal capacity meant tough tradeoffs. Some denials went unappealed, while others were downgraded early, leaving reimbursement at risk.
The hospital tested a more targeted, scalable workflow by prioritizing denials that were typically written off, tightening case identification and triage, and applying a more consistent appeal strategy. The results revealed meaningful upside in cases previously considered “not worth appealing.”
Over time, the team strengthened payer follow-up and accountability, improved turnaround times, and established ongoing feedback loops to surface prevention opportunities—especially around clinical documentation and upstream process fixes. In the first year, the hospital referred 9,234 cases and recovered more than $40M, building a more insight-driven program to protect revenue and improve long-term performance.
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