Clinical Denials

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Start capturing more clinical denials revenue.

Clinical denials account for up to 5% of a hospital’s net patient revenue, but workforce shortages, lack of technology, and rising denial rates make it difficult for RCM teams to overturn them and secure revenue.

Our appeals process–powered by our deep payer expertise, data-driven insights, and purpose-built AI and machine learning–is designed to maximize overturn rates for clinical denials and recover revenue that might otherwise be lost. Our flexible solutions allow us to develop complementary programs relative to our clients’ needs.



See the results that matter:

  • Overturned Denials
  • Increased Revenue
  • 73% average improvement over baseline recovery performance
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CASE STUDY

See how Knowtion resolved clinical denials for one health system.

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Challenge

One midwestern health system with 11 hospitals partnered with Knowtion to manage a wide range of clinical denials–whether for smaller disputes or large outstanding payments.

The Solution

In one instance, a payer claimed authorization didn’t match the CPT code billed for an MRI. Our team:

  1. Contacted the payer and, through verbal appeal, obtained retro authorization in under one day.
  2. Submitted the claim for reprocessing.
  3. Secured a payment of $1,700 for the health system six days later.
  4. Knowtion’s deep coding expertise and knowledge of the payer’s preferences for verbal appeals enabled such a rapid resolution.

 

In another case, the payer denied a claim for a minor surgery, stating again that the authorization didn’t match the code billed.

 

  1. Knowtion’s expert team reviewed the medical record and clinician notes to ensure proper coding.
  2. An attorney contacted the payer to review the code billed against authorized services and expected reimbursement.
  3. The attorney submitted a request for consideration to the payer’s portal.
  4. The payer overturned the denial, and payment of nearly $30,000 was posted in eight days.
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Results

Knowtion’s expert team, deep payer insights, and purpose-built AI and machine learning technologies enable faster resolutions and payments for customers.

In the words of the client

“Knowtion's extensive experience with multiple payers and providers creates a deep focus on clinical denials. Assembling expertise in payer behaviors, clinical knowledge, coding guidelines, and legal insights allows them to identify and execute the most effective appeal process available. Their customized approach achieves maximum recoveries and faster turnaround.”

VP of Revenue Cycle

Why do leading health systems choose Knowtion Health?

We combine industry, medical, and legal expertise with AI and machine learning to resolve more clinical denials across all denial types and recover more revenue.

Discover the Knowtion difference.

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Power-up your clinical denials engine.

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