Incomplete Clinical Documentation Leading to Lost Reimbursements

$1.5M-$2.1M annually from commercial claim underpayments and denials • $1.5M-$2.1M annually per hospital from preventable commercial denials due to inadequate documentation specificity • $11.2M at-risk revenue per organization from coding inaccuracies

Analyst downloads remittance advice files, manually crosswalks denials to claim and chart data in Excel, emails coders and physicians for additional documentation, and keeps personal trackers to prioritize which underpayments and DRG downgrades are worth appealing. • Analyst manually compiles missing notes, labs, and imaging from the EHR, scans and uploads supplemental documents to payer portals, and tracks high-dollar commercial denials and appeals in Excel or Access databases to manage deadlines and follow-ups. • Analyst manually reviews long remittance codes, copies data into spreadsheets, pulls the full chart from the EHR, and collaborates via email and informal meetings with CDI, coding, and providers to reconstruct missing documentation needed for redeterminations or appeals.