Case Studies > Arizona Health System

Titan Health Tackles Arizona Underpayment Issues for Two Health Systems

Key Takeaways

A large Arizona Payer's unique billing and coding requirements are affecting reimbursements for certain Arizona Hospitals. Certain payors' contracts may have unique language with specific coding, billing, and reimbursement requirements that may deviate from your standard contracts and billing processes. Titan Health identified $8.3 million in missing reimbursements for a large Arizona health system and $5.2 million for a mid-sized system.

Overview

Some Arizona payor contracts may have unique language with specific coding, billing, and reimbursement requirements that may deviate from standard contracts and billing processes. This creates an unprecedented opportunity to uncover missing reimbursements for Arizona health systems. As an Arizona-based company with deep knowledge of the local market, our team at Titan Health has identified and addressed this state-specific issue for multiple healthcare organizations.

To measure this effect, we engaged with over 20 hospitals and healthcare facilities in Arizona to conduct billing analyses. Recent analysis on a limited dataset showed average hit rates of almost 50% of sampled accounts eligible for additional reimbursement on targeted payors. This high percentage was observed even in health systems with existing zero-balance vendors, underscoring the widespread nature of the issue. Fortunately, we have the specialized capability to address it, which we did for two local systems.

The Challenge

Two health systems in Arizona, one a large system and the other a mid-sized system were concerned about potential underpayments from an Arizona payor. Due to the unique nature of the payor's reimbursement guidelines, most auditors and zero-balance vendors were unaware of or missing these opportunities.

The Solution

Recognizing the unique challenges posed by this payor's non-standard reimbursement practices, we leveraged our deep understanding of the Arizona healthcare market and the specific billing challenges and intent it created. We worked with both organizations to conduct comprehensive audits tailored to each health system's needs and circumstances.

Our approach included:

Thorough analysis of claims data to identify potential underpayments
Application of Arizona-specific knowledge to uncover overlooked reimbursement opportunities
Utilization of proprietary tools and methodologies to efficiently process large volumes of claims
Collaboration with each organization's revenue cycle team to ensure seamless integration and minimal disruption to existing workflows
Rapid implementation of findings to expedite the rebilling and collection process

This tailored approach allowed our team to quickly identify and address underpayments that both internal teams and other zero-balance vendors had missed

The Results

Working with both health systems' teams, we achieved the following results:

Organization 1 (Large System)

Total Identified: $8,349,511.97
Total Collected: $6,397,247.36
70% ($5.9 million) of the identified amount was rebilled and collected in under 45 days.

Organization 2 (Mid-sized System):

Total Identified: $5,228,769.11
Total Collected: $2,762,838.12
For claims with a payment, the average time from rebilling to payment was 25 days.

Reach out to Titan Health

As an Arizona-based company, we're uniquely positioned to help health systems and other healthcare facilities in the state recover underpayments from billing and reimbursement auditing. These successful partnerships demonstrate our ability to partner effectively with different-sized organizations, quickly identify underpayments, and efficiently collect substantial amounts of missing reimbursements.

We can do a quick assessment to determine if these opportunities apply to your facility for free. This assessment would only take a few days with simple claim data and contracts. Because this is a single-issue assessment, there is no need for long-term contracts or supplanting an existing vendor. It's simple and easy and could lead to significant recoveries.

Our Titan Health team specializes in coding and billing review, ensuring you are getting the correct reimbursement for the services rendered in these unique scenarios. So, for healthcare organizations in Arizona, partnering with Titan Health represents a quick and significant opportunity to recover funds that might otherwise be lost due to unique billing and reimbursement issues.

Are you a health system based in Arizona? Contact Titan Health to find the money you’re leaving on the table. Reach out for an assessment today.