Patient and Family Friction from UR‑Driven Denials and Documentation Disputes

$100,000-150,000 annual from early VA patient discontinuation (patients leave when confused by billing); cash flow impact from delayed authorization reimbursement (30-60 day holds common); billing staff overtime/frustration (20+ hours/month manual follow-up) • $100,000-150,000 annual from veteran patient discontinuation; loss of VA contract preferential status if patient satisfaction scores decline; reputational damage in military community (close-knit referral networks) • $100,000-150,000 annual from veteran patients discontinuing residential mental health care when authorization delayed; lost VA contract volume; reputational damage affecting military community referrals

Ad-hoc note aggregation in Word/Excel and peer-to-peer calls with payers to justify medical necessity. • Billing Specialist maintains manual aging report of VA authorizations pending/denied; follows up via phone with VA reviewer; tracks appeal status on Outlook calendar; must manually adjust patient billing statements when authorization changes • Billing specialist manually reconciles payer determinations, clinical notes, and patient financial expectations using ad-hoc spreadsheets, email threads, and phone notes to craft explanations, re-estimate patient responsibility, and track which families are disputing denials or threatening to discontinue care.