Partnership Powered by Results
$53M+
recovered in overturned clinical denials
100%
successful recovery of $74K claim
40%
expected reimbursement yield increase
RESULT
Specialized Appeals Expertise:
- Leveraged in-depth knowledge to navigate complex claims processes and secured over $53 million in disputed claims, contributing to a 40% expected reimbursement yield increase
Successful High-Value Recovery:
- Achieved 100% recovery of a $74K+ claim for an innovative cardiac device
Pioneering Coverage Precedent:
- Established precedent for the coverage of emerging medical technologies
CHALLENGE
Navigating Complex Denials:
- Faced clinical denials for new medical technologies labeled as “experimental”
Challenging Appeal Processes:
- Required multiple appeal levels, including Administrative Law Judge hearings
High-Stakes Impact:
- Excessive denials put critical patient care and reimbursement at risk
SOLUTION
The solution required clinical, legal, and administrative expertise to navigate the complex appeals process. Aspirion addressed the denials by taking these steps:
In-Depth Clinical and Regulatory Analysis:
- Collaborated with physicians and legal counsel to prove the medical necessity of denied treatments
Exhaustive Appeals Management:
- Pursued all appeal levels, including Administrative Law Judge hearings
Evidence-Based Arguments:
- Partnered with the device manufacturer to create appeals using clinical data, medical literature, FDA evaluations, and Medicare criteria
“We have an incredible rate with Aspirion. The firm definitely doesn’t nickel-and-dime us for anything. The rate is simply the percentage that I have negotiated. Aspirion’s rate is the best and lowest percentage rate of all of our other vendors. Aspirion has done an incredible job for us. If the firm were to ask to use me as a reference, I certainly would be happy to do that for them. I could not say a bad thing about Aspirion.”
About the Provider
- 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.