Proof Point | The White Stone Group, Inc.

Hospital/Patient Relationship and $75K Saved

Provider: Arizona Hospital
Dollar Value: $75,220.00
Communication Event: VoiCert
Challenge: Risk of denial and surgery cancellation
Benefit: Recovery of $75,220.00

The night before a scheduled surgery, a payer claimed that it had received an authorization request for only half of a two-procedure surgery. As a result, the payer was only going to authorize half of the scheduled procedure.

The patient access department used TRACE to locate a recording of the call placed to request the authorization, including CPT codes for both procedures. When the department offered to send a transcript of the call, the payer gave authorization for both procedures.

Without the approval, the hospital would have lost $75,220, or would have been forced to cancel the procedure the night before surgery. This would have resulted in the loss of valuable time in surgery, time for the physician and service to the patient.