Partnership Powered by Results
$1.2M
recovered in overturned chemo drug denials
70%
sucess rate in overturning denials
40%
expected reimbursement yield increase
RESULT
Superior Recovery Success:
- 70% success rate in overturning denials, far exceeding initial expectations and contributing to a 40% expected reimbursement yield increase
Rapid Financial Gains:
- Over $1.2 million recovered in disputed claims due to legal expertise
Uncovered Policy Loopholes:
- Increased understanding of the payer’s unusual specialty pharmacy policy to avoid future denials
CHALLENGE
Uncovered Revenue Gaps:
- Unexpected denials of high-cost chemotherapy drugs due to a surprise payer policy
Inconsistent Denial Patterns:
- Inconsistent denials, justifications, and outcomes for recurring patients
Operational and Financial Strain:
- Potential disruption to patient care and hospital operations due to drug unavailability
Processing Inefficiencies:
- Lack of simultaneous processing for all bills caused delays
SOLUTION
Aspirion’s solution required technical and legal expertise, understanding complex issues, crafting effective appeals, and persistently escalating multiple appeal levels through:
Legal Review of New Policy:
- Aspirion’s attorneys uncovered flaws in the payer’s arguments through in-depth analysis
Claim Denial Tracking:
- Aspirion tracked every claim to spot denial trends and appeal successes
Tailored Appeals Letters:
- Aspirion’s legal team crafted sharp, customized letters highlighting patient care, hospital impact, and contracts
“Aspirion has been very responsive and flexible. The team of people who we worked with during the implementation was outstanding. We have access to people who can make decisions, and we have regular check-in calls with operational stakeholders. We like the firm to be able to show the key statistics, talk through them, and let us know whether they see an opportunity. That is the approach that Aspirion has shown so far. They collaborate, listen, and are adaptable. They have good people skills and communication, and they are a good partner. Aspirion doesn’t just sell us something for the sake of selling something and charge us for every little thing. They spend time listening to and understanding us. They are transparent about what they cannot do. The partnership has been our highlight with Aspirion.“
About the Provider
- Leading university-based medical center with expertise in 100+ specialties
- Operates nearly 40 outpatient sites with 1,800 providers and scientists
- Home to nationally ranked eye, cancer, and cardiac centers