HealthWide Solutions can assist you with Denials, Underpayment and/or Lost Revenue.

Our audits focus on the following:  

  • Strategic Risks - Impairments to the strategic mission of the organization
  • Operational Risks - Impairment of the ability to carry out day-to-day operations - clinical and business related as well as employee execution of job functions.
  • Compliance Risk - Failure to comply with laws, regulations and internal policies designed to safeguard the system.
  • Financial Risk - Loss of financial resources or assets.
  • Reputational Risk - Public image and patient relation issues that may be damaging.
  • Application/System Control Risks - Shortcomings of applying system controls throughout the clinical and/or business office areas. Whether this be employees having access to areas they should not, or inappropriate system builds and roll-outs resulting in mandatory entry fields being passable resulting in poor data downstream.

Most denials are broken down into Hard Denials which require an appeal or Soft Denials where additional info is required.  

Hard Denials: 
Not covered service 
Charge/procedure as bundled 
Untimely filing 
Not financially responsible 
Lack of pre-authorization 
Days, service, or level of care for no concurrent authorization 

Soft Denials: 
Pending medical records 
Missing/inaccurate information  
Uncovered codes or charges 
Drug or implant reimbursement 
Secondary pending receipt of primary EOB