Case Study: Reducing Denials, Write-Offs and $2.5 Million in Bill Holds

A 300-bed acute care facility facing key case management vacancies was experiencing several operational and financial challenges, including inconsistent InterQual compliance, a backlog of one-day-stay bill holds and communication gaps between nursing and case management. These issues were affecting efficiency, admission status accuracy and overall revenue cycle performance.

An HCT interim leader was brought in to provide day-to-day leadership while the facility searched for permanent staff. By strengthening communication, InterQual compliance, admission status and revenue cycle processes, the interim leader stabilized operations and helped build a stronger foundation for ongoing performance.

Key Results:

• Reduced denial rates from 19% to 11%.

• Improved 24-hour InterQual reviews from 50% to 90%.

• Reduced Medicare one-day-stay write-offs from 18% to 6%, saving nearly $200,000 per month.

• Reduced bill holds from more than $3 million to $500,000.

• Decreased length of stay by 0.8 days.