Customer Success Story
Case Study: Revolutionizing Healthcare Revenue Recovery with AI-Powered Denial Management
The Challenge
Healthcare providers routinely encounter significant obstacles in addressing claim denials, which often result in substantial financial setbacks. Manual processes consume valuable time and resources, with an average of $10 billion spent annually to rectify erroneous denials. These inefficiencies underscore a critical need for innovation in Revenue Cycle Management (RCM) to enhance operational efficiency and maximize revenue recovery.
TSI's Innovative Solution:
TSI’s AI-enabled Denial Management Solution represents a paradigm shift in RCM, leveraging state-of-the-art technologies to streamline denial analysis and expedite appeals processes. At its core, the platform integrates:
- Advanced Automation: Through robotic process automation (RPA), intelligent document processing (IDP), and generative artificial intelligence, TSI’s platform accelerates the analysis of denial patterns, swiftly generates appeal drafts, and ensures precise and effective responses to claim denials. This automation drastically reduces manual efforts, minimizes errors, and accelerates claims resolution timelines.
- Predictive Insights: Powered by intelligent algorithms, TSI’s proprietary platform analyzes vast datasets to identify patterns, trends, and payer behaviors. This predictive capability equips providers with actionable insights, anticipating payer arguments and optimizing appeal strategies for higher success rates.
- Proven Results: TSI’s Denial Management Service has yielded impressive outcomes, including an 86% denial overturn rate, a 42% increase in payment per appeal, a 50% reduction in time to appeal, and a 53% decrease in days to pay. These metrics not only underscore the efficiency gains but also translate into substantial financial savings and improved revenue cycle performance.
- Comprehensive Support: Beyond technology, TSI offers healthcare providers ongoing guidance and expert support. This ensures providers have the necessary resources to navigate the complexities of denial management effectively, make informed decisions, and optimize their revenue recovery strategies over the long term.
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Impact and Benefits:
TSI’s AI-powered Denial Management Solution not only addresses the immediate challenges of revenue recovery but also empowers healthcare providers with strategic advantages:
- Enhanced Efficiency: Automation reduces manual workload, accelerates claims processing, and minimizes errors, thereby optimizing operational efficiency.
- Expanded Work Effort: Intelligent algorithms enhance revenue pursuit options on denials that were previously deemed uneconomic allowing for 100% denial review for all claims.
- Improved Financial Health: Increased overturn rates and reduced time to payment translate into significant revenue recapture and cost savings.
- Strategic Advantage: Predictive insights and comprehensive support enable providers to proactively manage denials, improve decision-making, and achieve sustainable financial health.
Conclusion:
In conclusion, TSI’s AI-powered Denial Management Solution represents game-changing innovation in healthcare RCM. By harnessing advanced technologies to automate processes, provide predictive insights, and deliver comprehensive support, TSI empowers healthcare providers to navigate the complexities of denial management with unprecedented efficiency and effectiveness; building trust in the use of AI in the healthcare space. As the healthcare landscape continues to evolve and transform, TSI remains committed to pioneering solutions that redefine revenue recovery and drive sustainable growth for healthcare providers nationwide.
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Customer Experience/Care Management
Inbound & Outbound Voice
CX & Care Programs
Back-Office Functions
Performance Analytics
Flexible Global Staffing
Business Process Outsourcing
Data Input
Document Processing
Verfication & Validation
Exception Processing
QA Monitoring & Reporting
Business Analytics & Modeling
First Party ARM
1st Party Collections
Pre-Charge Off Program Support
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third Party Debt Collection
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Late-Stage Recovery
Innovative Technology & Approach
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