Rehabilitation center needs to get insurance denial rates in better shape

Key metrics:

Reduced claim denial rate by ~45%, leading to an acceleration of >$2M in collections.

Value levers pulled:

Operational efficiency improvements
Cost reduction
Revenue acceleration
Predictive analytics

Picture this...

You’re a chain of residential rehabilitation centers providing treatment for emotional trauma, addiction, depression, and other psychological disorders. But you’re dealing with excessively high rates of insurance claim denials, and you need to identify the clinician notes, records, and attributes that have a higher chance of denial due to poor clinical documentation.

You turn to Accordion.

We partner with your team to analyze the Electric Medical Records (EMR) to identify the correlation between EMR text and authorization denials. We:

Integrate and consolidate EMR data from different EMR systems such as KIPU, Easystep, and Sigmund.
Identify key patterns in the claims with higher denial/approval rates (no medical justification, recurring phrases, etc.).
Predict the denial probability of a claim using Artificial Neural Network Algorithms.
Create BI reporting infrastructure to monitor the quality of the EMR documentation.
Create daily reports for the EMR team to provide access to the consolidated EMR data and provide visibility into the records/clinicians who have a higher potential for a denial at a patient level.

Your value is enhanced.

With a better understanding of the claim attributes that lead to denials, you can now predict potential denials on a near real-time basis and train your clinicians to improve the quality of their documentation. This leads to a reduction in your denial rate by ~45%, which results in an acceleration of >$2M in collections and improves the predictability of cash flows.

Enhanced value:

You reap multiple benefits, including:

Reduced claim denial rate by ~45%, leading to an acceleration of >$2M in collections.