Multi-site surgical practice slashes write-off rate by 72% and eliminates intraoperative prior-auth write-offs.
Apex Orthopedic & Spine Institute · 18 Orthopedic & Spine Surgeons · Atlanta, GA · Systems: Epic Community Connect, Availity
The Challenge
Apex was losing over $1.2M annually on CO-197 and CO-97 denials. Complex spinal surgeries frequently required unplanned intraoperative procedures that were not covered under the original pre-cert. Commercial payers routinely denied the entire surgical claim.
The Breaking Point
A wave of Medicare Advantage prior-auth denials from UnitedHealthcare and Elevance pushed aging A/R past 90 days, threatening clinic cash flow.
The Solution & Implementation
RecoupOps's clinical appeal generation engine was deployed to automatically extract intraoperative surgeon dictations, link LCD guidelines, and build multi-page clinical justification packages within 15 minutes of remittance arrival.
“Before RecoupOps, our billers were drowning in 80-page surgical charts trying to craft appeal letters. With RecoupOps, the clinical packet is 95% complete before a biller even opens it. Our physicians are thrilled that their hard work is finally getting paid.”
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