Laboratory Denied Claims Case Study

AIMA diligently pursued over 1,700 erroneously denied claims with a 100% success rate to recover $76k in lost revenue for our lab client.

Find out how our medical billing auditors initiated a tenacious program of pursuit of all claims. See how the lab now benefits from cleaner claims and speedier reimbursement.

Scenario

A large Maryland-based laboratory working with providers across the United States came to AIMA with a significant volume of unpaid denied claims. Like many laboratories, they encounter ongoing challenges navigating the complex health insurance reimbursement matrix. They chose to work with AIMA as their RCM partner due to our extensive industry knowledge and experience, particularly our aged claims recovery success.

With over 1,700 historically denied claims, some dating back almost two years, our priority was to ascertain the root cause of the rejections. All claims were specific to COVID reimbursement during the Public Health Emergency. It appeared the claims were submitted per the insurance provider’s instructions and subsequently denied as untimely.

Solution

The AIMA team immediately identified that the denials were in error and the claims should have been paid. We initiated a tenacious program of pursuit of all claims. Our dedicated project team of trained claims auditors sorted and ordered claims by financial class and days. We then methodically made telephone contact, issued letters and sent follow-up emails to the insurance company demanding payment for every single denied claim. At no point did we give up, as is our reputation for diligence and relentless collection of maximum revenue previously listed as non-collectable by the regular billers.

Outcome

All denied claims were successfully paid, recovering approximately $76,000 in unpaid revenue for our client. AIMA has now implemented an end-to-end RCM billing and account receivable process for the client to ensure seamless and speedy reimbursement.

100% success rate on reimbursement of unpaid claims

$76,000 aged debt recovered