Hospital Denials: The Money You Leave on the Table
Retroactive auditing is an autopsy: the patient (money) is already dead. AI performs predictive auditing before the bill is sent.
Equipe Financeira
FinHealth Team
The denial (glosa) cycle is vicious and stupid. The hospital makes a billing error, the health plan denies it 30 days later, the hospital appeals, and the money stays locked for months. It's a war where both sides lose efficiency.
Traditional Auditing is done by sampling (analyzing 10% of the highest bills). This means 90% of bills pass with small errors that, when summed up, turn into millions.
Predictive Auditing (Pre-Bill)
Our AI audits 100% of bills in real-time, before they are sent to the health plan. It compares the record with the bill:
- "The doctor prescribed Tylenol, but it wasn't charged on the bill." (Revenue loss avoided).
- "An Operating Room Fee was charged, but there is no surgical description in the record." (Denial avoided).
By correcting the error at the source, we reduce technical denials by up to 70%. Transform your billing department from an "error fixer" to a "revenue guarantor".