Billing Bottlenecks from Manual Multi-Payer Processing

$100,000-$140,000 annually (compliance officer time on work comp appeals + appeal rejection from poor documentation + delayed work comp collections) • $100,000-$200,000 annually (self-pay typically 10-20% of outpatient volume; 15-25% of self-pay balance write-off due to poor tracking; $5,000-$10,000 weekly revenue impact) • $100,000-$250,000 annually (QA labor + Medicare denials + audit risk; OIG recovery audits can result in $50k-$200k clawbacks for systematic non-compliance)

Credentialing and billing staff track workers comp cases in separate Excel logs or Access databases, email adjusters directly, scan and upload documents manually, and maintain paper folders to remember which claims are awaiting authorization or additional records. • Credentialing staff make phone calls to payer hotlines, log into payer portals to verify benefits, and record outcomes in Excel or on paper before charges are released; denied claims are then tracked in separate spreadsheets and email lists for recoding and appeals. • Excel spreadsheets and manual payer rule lookups