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Clinical Denials

You’ve Got This Now

Overturn denials
Increase revenue
Dedicated expertise

Capture more clinical denial revenue with our experienced team of lawyers, doctors and nurses

Clinical denials are on the rise and can represent as much as 3-5% of your hospital’s net patient revenue.

If you, like so many hospitals, are experiencing a build-up of clinical denials, an overworked revenue cycle team, staffing challenges and payers delaying on appeal decisions and payments, Knowtion Health can help.

Clinical denials don’t have to be this painful. Knowtion Health can have you saying: You’ve got this now.

Knowledge and Experience

When your resources are limited, it’s a struggle to bring ROI to your clinical appeals. At Knowtion Health, we bring a diversified bench with unique strengths and credentials - industry, medical, and legal certifications, including dedicated nurse teams with utilization review and case management experience. Using a customized appeals process, on average, we overturn 65% of the medical necessity and no authorization denials.

We have teams who’ve also worked on the payer side of healthcare, which gives us the inside track to insurance claim resolution and allows the system to work with us, instead of against us. We often attend payer meetings with our clients and bring account examples to share with the payers who are denying in error.

In addition, we have physician resources to assist on complex appeals and a dedicated, certified billing and coding team. We’ll also provide reporting and staff education specific to the trends and root causes so they can be corrected sooner to reduce future denials.

Increased Revenue & ROI

Your goal is always to generate the best ROI at the greatest efficiency. If you are submitting canned denials, you’re likely overturning less than 30%. Knowtion Health can help you increase those rates on average to 65% using our dedicated team and customized appeals process. That’s additional ROI that adds to the bottom line and doesn’t result in lost revenue.

You’ll also save by reducing write-offs by winning more appeals and reducing capital technology investments knowing that the latest in machine learning is being used to work your accounts.

Get in the Know

With our robust reporting, providing not only placement and revenue reporting, but also trending information on root cause and payer trends, Knowtion Health ensures you know what’s happening with your inventory.

We also provide complimentary educational training specific to your denials and payers, to help you improve processes and reduce future denials.

Improved A/R

If you’re only recovering 30% of your clinical denials, it’s contributing to the aging of your A/R.

Rely on the Knowtion Health team to get your clinical claims appealed and overturned. This will allow you to not only achieve the revenue on paid reimbursements but also allocate employees working these accounts to more profitable work.

We have a nimble implementation process and are equipped to work with any hospital-based billing system.

Faster Resolution of Accounts

We have a dedicated, skilled team who triages your account to identify problems, improve processes and resolve denials. Using a customized appeals process, on average, we overturn 65% of the medical necessity and no authorization denials.

What Makes Us Stand Out From the Rest

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All Type of Denials

No denials are off-limits, including technical and administrative denials. With clinical denials, 75% of what we manage often relates to no-authorization and medical necessity denials.

Location

Customized Appeals Performed by U.S. Based Teams

When your resources are limited to bring ROI to your clinical appeals, we can bring a diversified bench – all U.S. based with unique strengths and credentials - industry, medical, and legal certifications, including dedicated nurse teams with utilization review and case management experience. Using a customized appeals process, on average we overturn 65% of the medical necessity and no authorization denials.