Creating Extraordinary Outcomes
Through Exceptional Processes

Healthcare Case Studies

Claims Management - Process Innovation and Technology Result in Cost Reductions

The Challenge: Prohibitive labor cost and considerably higher turnaround time due to large number of manual adjudications resulting from mismatched information between enrollment data and provider data. Read more

Category: Healthcare Payer


Provider Data Management - Process Innovation and Technology Result in Cost Savings

The Challenge: A cost intensive update process that required checking all data on provider information update form rather than ones which were changed (typically only 40%). Read more

Category: Healthcare Payer


Risk Score Optimization through CDI

Scope: A major university-based health system wanted a thorough review of their documentation to see if it was supporting the level of care they are providing to the risk adjusted patient population. Clinical documentation review is a vital process for any patient encounter because this facilitates accurate representation of a patient’s clinical status that translates into capturing the ICD-10 codes to the highest specificity. Read more

Category: Healthcare Payer


High Aged And Complex AR

The Client: A leading, multi-specialty medical group and health system, this customer has multiple outpatient specialties with 300+ physicians. Approximately $600M+ in charges and $170M+ in collections annually. Read more

Category: Healthcare Provider


Coding Auditing RAC - Health System

Client Details: Our client is a major health system with multiple hospitals. Vee Technologies provides various services including Coding, Auditing, and RAC (Recovery Audit Contractor) review process for this client. The Recovery audit program is an audit program to identify improper Medicare payments including overpayments and underpayments as a result of coding issues. All the hospitals in this health system send the audit recommendations they receive from RAC to Vee Technologies coders to validate the audit findings. Read more

Category: Healthcare Provider


Revenue Optimization & Staff Augmentation for a major health system

Challenges: Our client, a major university health system, was looking to optimize revenue. They had millions of dollars on hold as the claims hit the clearing house due to improper coding, POS and modifier issues, demographic mismatch etc. Providers may have given illegible medical reports which prevented the coders to code with highest specificity. Unavailability of experienced staff created a backlog which caused revenue leakage. Clearing the denials within the TFL was another challenge due to the shortage of expert coders. Read more

Category: Healthcare Provider


Case Study: Bridging analytics and CDI for optimizing risk adjustment suspect condition capture

Executive Summary - Most providers participating in risk adjusted contracts view risk adjustment optimization as a function of revenue enhancement. Most providers participating in risk adjusted contracts view risk adjustment optimization as a function of revenue enhancement. However, risk adjustment optimization is now an autonomous competency function critical for overall provider success in the risk adjustment sector Read more

Category: Healthcare Analytics


Case Study: Eastern washington hospital leveraging india resources amid fiscal pressures

Executive Summary - The maturity of an organization determines its scalability and operational agility to adjust to shifting reimbursement structures, specifically alternative payment models. At a 300-bed hospital in Eastern Washington, patient volumes for commercial and federal payers have consistently decreased due to the competitive landscape within the region, a talent deficiency, payer exclusivity clauses, and legacy staff using aged methodologies in a 'new age' environment. Read more

Category: Healthcare Analytics


AR Denials & Liquidity

Challenge: A major hospitalf realized three consecutive quarters of declining net collections. Read more

Category: Healthcare Analytics


DNFB Analysis

Challenge: DNFB over $9,000,000 for three consecutive months equating to 12 days of encounters. Read more

Category: Healthcare Analytics


ICD- Impact Analysis

Challenge: Client had exponential decrease in charges per encounter. Read more

Category: Healthcare Analytics


Cost & Utilization Analytics

Challenge: Cost and Utilizations weren't viewed at Physician, Hospital, Enterprise, and Health Plan.

Read more

Category: Healthcare Analytics