Unappealable Denials: How to Review & Determine the Most Difficult Cases 

Our client, a large healthcare system with four hospitals, was confronted with a serious issue: a sharp increase in what they considered unappealable payer denials. This led to several ongoing challenges, including:

• Discrepancies in their revenue cycle denial budget

• Difficulty managing a growing number of write-offs

• Challenges in determining if accounts were genuinely unappealable

​This situation is especially concerning because payers often reject legitimate payments when denials aren't appealed, and their decisions go unchallenged. As a result, hospital revenue is directly impacted, which can also affect the renewal of payer contracts. Our team of clinical appeals specialists, analysts and educators worked together to develop a system-wide solution for the client.

Download the case study and contact us to learn more about denials management services.