CASE STUDY

Denials Management

Over $53 Million Recovered in Overturned Clinical Denials

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At a Glance

Challenges

Complex clinical denials for new medical technology labeled as “experimental”
Multiple appeal levels required, including Administrative Law Judge hearings
Critical patient care and reimbursement at risk due to excessive denials

Solutions

Specialized Team: Leveraged Aspirion’s specialized legal and technical expertise
Clinical Analysis: Aspirion-physician collaboration to prove medical necessity
Evidence-Based Approach: Developed appeals using clinical data, literature, and Medicare criteria
Appeals Management: Pursued all appeal levels through ALJ hearings

Results

Over $53 million recovered in disputed claims through specialized appeals expertise
100% successful recovery of a $74K+ claim for innovative cardiac device
Established precedent for coverage of emerging medical technologies

$53M+

recovered in overturned clinical denials

$100%

successful recovery of $74K claim

About the Hospital

As a prominent Mid-Atlantic organization with two acute care hospitals and over 130 sites of care, the healthcare system provides clinical, educational, preventive, and social programs. With about 12,000 team members, it is also home to fitness and occupational health centers, plus hospice care.

“I would recommend the firm because of the fact that they work closely with us, implement things, collaborate, have the right skill sets, and speak to us at our level. They understand the nuances of the workflow, so I like that I don’t have to explain to someone what something is and where to go; they already know that.“

-Director, Aspirion Denials Management Client