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Medical

Case Study

Reducing Claim Denials

A Leading US Hospital's Data Approach

Claim denial rate
Data quality issues
Revenue leakage
Data mismatch

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Situation

The client is a prestigious Magnet Hospital in the United States with substantial annual revenues. As a leading healthcare institution, they faced challenges related to data quality issues that resulted in a higher than benchmark claim denial rate. Critical information required for claim submission was missing, patient information was incorrect or incomplete, and there was a data mismatch between the clinical and financial systems. The client sought a comprehensive solution to evaluate patient encounter records and reduce revenue leakage caused by data quality issues.

Prior to implementing Routine’s data quality solution, the client faced numerous challenges:

Services were provided, but critical information necessary for claim submission was missing.
Patient information was incorrect or incomplete, leading to claim denials.
There was a data mismatch between the clinical and financial systems, causing further inconsistencies.

Solution

The client implemented Routine’s AI-powered data quality solution to address these challenges. The solution autonomously identified data quality rules and issues, allowing for effective data evaluation and optimization. The following outcomes were achieved:

Identification of $5 million worth of incomplete and inaccurate claims data in just one quarter. Routine’s solution detected missing information, inconsistencies, and errors, enabling the hospital to rectify and improve the data quality of its claims.
Identification of several process improvements to ensure long-term fixes. Routine’s solution not only highlighted existing data quality issues but also provided insights and recommendations to address underlying process inefficiencies and prevent future data inaccuracies.

Results

The implementation of Routine’s data quality solution resulted in significant improvements for the hospital:

30% reduction in claim denial rate: By identifying and rectifying data quality issues, the hospital significantly reduced claim denials, leading to improved revenue collection and financial performance.
Engagement to impact in just 10 business days: Routine’s solution quickly and efficiently evaluated the hospital’s patient encounter records, identifying data quality issues and generating actionable insights within a short timeframe.
No technical effort required: Routine’s solution seamlessly integrated with the hospital’s existing systems and processes, eliminating the need for extensive technical modifications or disruptions.

By leveraging Routine’s data quality solution, the hospital successfully optimized its data, reduced revenue leakage, and achieved better financial outcomes while ensuring accurate and complete patient encounter records.

Medical

Reducing Claim Denials

Let’s discuss !

Situation

Solution

Results

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