Specialty Revenue Cycle Claim Management Case Study

This case study details the successful resolution of a challenging VA claim by a New York-based healthcare system that faced underpayments and denials. The claim, which was over 180 days old, was at risk of being written off due to the organization's lack of technology and expertise in managing specialty revenue cycle claims. EnableComp was engaged to assist in the recovery process. Within 72 hours, EnableComp identified the issues and outlined a path to resolution. The claim was successfully resolved within 60 days, resulting in a recovery of $540,000, which was 12% over the net expected reimbursement. The case study highlights the common challenges faced by hospitals, including staffing shortages and payer friction, and emphasizes the importance of specialized expertise in revenue cycle management. Following this success, the healthcare system plans to formalize and expand its relationship with EnableComp to address additional specialty classes.