Representative recovery scenarios

The challenge

• ~62% telehealth visit mix across providers
• Prior-auth denials averaging ~14% of claims
• Time-based code under-utilization (90834 logged where 90837 was earned)

Our approach

• Centralized prior-auth tracking across the full provider roster
• Place-of-service and modifier rule engine updated weekly per payer
• Documentation-based review for 90834 → 90837 promotions

The challenge

• Chronic care management (CCM) revenue largely uncaptured
• Inconsistent E/M leveling across providers
• Aging A/R past 90 days representing >18% of total balance

Our approach

• Annual Wellness Visit and CCM capture program build-out
• E/M leveling support based on documentation, with provider-level scorecards
• Structured A/R recovery worklist by aging bucket and payer

The challenge

• Bundling and modifier errors on procedure + same-day E/M
• Slow follow-up on $5K+ catheterization claims
• Device interrogation coding inconsistencies

Our approach

• Specialty-trained coders reviewing every high-dollar claim before submission
• Aggressive high-dollar denial appeals workflow with dedicated turnaround SLAs
• Device interrogation coding standardized across the group