The Challenge: High Denials, Frustrated Teams, and Lost Revenue
When this OB/GYN group approached us, they were facing a challenge all too familiar in women’s health practices: a denial rate consistently above 18%. Despite having a seasoned billing team, claims were being returned, delayed, or written off far too often.
Their denial patterns weren’t random. We found clusters around:
- Missing prior authorizations
- Eligibility mismatches
- Coding inconsistencies, especially for bundled services
- Documentation gaps
This resulted in revenue delays, rework across the billing team, and growing friction between front-desk operations and revenue cycle management.
Step 1: Diagnose the Denial DNA
Before fixing, we needed clarity. Our RevShield A.I. platform was deployed to map denial trends across:
- CPT codes and modifiers
- Provider-level billing habits
- Payer-specific rules
- Timing of follow-up and appeal
This diagnostic approach helped us pinpoint that over 60% of denials could be prevented upstream, during intake, charge entry, and pre-bill audits.
Step 2: Automate the Invisible Workflows
We introduced targeted automation at critical junctions:
- Eligibility & benefits verification with real-time payer data
- Prior auth tracking through our Prior Auth Smart module
- Pre-bill scrub rules for OB/GYN-specific coding combinations
- Auto-routing of flagged claims to the QA team before submission
This reduced human error, sped up verification, and ensured that incomplete claims never left the system.
Step 3: Align People, Not Just Processes
No technology works in isolation. We worked closely with the front desk, coders, and AR team to:
- Redesign intake forms to capture complete data
- Conduct weekly denial huddles with actionable insights
- Set up real-time denial alerts tied to specific workflows
- Provide physician education on documentation gaps
The entire team was now speaking the same language: data-driven prevention.
The Results: From 18% to 6% Denials in Just 90 Days
Within 3 months:
- Denial rate dropped from 18% to 6%
- First-pass resolution rate climbed by 34%
- Average AR days reduced by 22%
- Appeals workload fell by nearly half
More importantly, the practice’s leadership saw improved morale across teams. Billing wasn’t a blame game anymore—it became a source of confidence.
What This Means for Other Practices
OB/GYNs aren’t alone. Across all specialties, denial management is still one of the most under-optimized aspects of RCM. But the lessons are clear:
- Prevention always beats correction
- Visibility transforms accountability
- Integrated tech and team alignment produce lasting gains
Final Thoughts
Cutting denials by two-thirds isn’t magic. It’s method. At iMagnum, we bring the tools, processes, and partnership mindset that make these numbers possible.
