Customer Success Story
AI-Powered Denial Management Increases Reimbursements for a Large Multi-State Physician Group
- Organization: National Ambulatory Surgery Center (ASC) Network
- Locations: 150+ ASCs Across 30 States
- Annual Revenue: $2.5 Billion
- Challenge: High volume of claim denials, lengthy appeals, and revenue delays impacting operational efficiency
- Objective: Reduce denials, automate appeals, and improve revenue cycle performance
The Challenge
A large multi-state physician group was struggling with denial rates exceeding 15%, delayed reimbursements, and an overloaded revenue cycle team. Manual appeal processes led to an average resolution time of 50 days, impacting revenue flow and increasing administrative costs.
Key pain points included:
- High volume of coding errors and missing documentation triggering preventable denials
- Slow, labor-intensive appeals process that strained staff resources
- Lack of real-time payer insights leading to inconsistent denial recovery
- Revenue leakage and cash flow constraints due to lengthy resolution cycles
To remain financially strong and improve operational efficiency, the group sought an AI-driven denial management solution that could:
✅ Reduce preventable denials
✅ Automate the appeal process
✅ Accelerate reimbursements
✅ Lower administrative burden
The Solution
TSI’s AI-Powered Denial Management
TSI implemented its AI-driven denial prevention and appeals automation solution, seamlessly integrating with the group’s EHR and practice management system. The platform provided:
✔ AI-Powered Denial Prevention – Predictive analytics flagged high-risk claims pre-submission, reducing avoidable denials by 32%.
✔ Automated Appeal Generation & Submission – AI instantly created and submitted payer-specific appeals, improving overturn rates by 45%.
✔ Smart Claim Prioritization – AI ranked denials by recovery likelihood, ensuring the highest-value claims were addressed first, cutting appeal resolution time by 53%.
✔ Real-Time Payer Intelligence – Machine learning continuously adapted to payer policy changes, reducing manual rework by 37% and increasing first-pass acceptance rates.
✔ Seamless Integration & Workflow Optimization – Fully embedded within the group’s existing revenue cycle processes, requiring no IT disruptions or retraining.
Results & Impact
📉 Denials Prevented: 32% reduction in avoidable denials
📈 Appeal Success Rate: 45% increase in overturned denials
📉 Resolution Time: 53% reduction in denial appeal turnaround time (from 50 to 24 days)
📉 Administrative Burden: 37% decrease in manual appeal processing
💰 Revenue Impact: $15.6M in accelerated reimbursements within 12 months
"TSI’s AI-powered denial management transformed our revenue cycle. What used to take weeks now happens in days. Automating our appeals process and leveraging AI-driven insights allowed us to focus on patient care while improving collections and cash flow. We’re recovering more revenue, faster, with far less effort."
- CFO, Large Multi-Specialty Physician Group
Conclusion
Intelligent Denial Management, Stronger Financial Performance
By leveraging TSI’s AI-driven denial management, this multi-state physician group reduced denials, automated appeals, and accelerated revenue—without adding administrative strain.
Let’s talk. Contact TSI today to see how AI can optimize your denial management and revenue recovery.
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