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Reduction of Coding Denials for a Texas-Based Physician Network with Revix Health’s Professional Coding Support
Overview
A large physician practice in Texas, known for delivering high-quality care through its expert provider team across Urgent Care and Emergency Department (ED) services, partnered with Revix Health to enhance medical coding operations and reduce denial rates.
“Partnering with Revix Health has been a game-changer for our organization. When we first transitioned, we were struggling with low coding accuracy and an overwhelming volume of coding-related denials that were significantly impacting our revenue cycle and staff morale.
The Revix team didn’t just step in—they embedded themselves in our operations, quickly identifying root causes and implementing corrective strategies. Within two months, our coding accuracy surged past 96%, and our ED and urgent care denial rates were cut by more than half.
Their dedication, expertise, and proactive communication have made a measurable difference in our performance. I can confidently say that Revix Health is not just a vendor—they are a trusted partner in our success.”
Vice President – Rev Cycle, Texas-Based Physician Network
Challenges
During the transition, it was identified that the previous coding partner’s accuracy was significantly below industry standards—at times, dropping as low as 80%.
Coding-related denials were alarmingly high, reaching 21%, which severely impacted cash flow and led to increased staff burnout due to excessive rework and appeals.
Solution Implemented
Strategic Involvement: Revix Health’s coding leadership team participated in all strategic discussions with the objective of reducing coding denials and improving quality metrics.
Rapid Quality Improvement: Within just 2 months, Revix Health coders achieved 96%+ coding accuracy, significantly reducing current claim denials.
SWAT Denials Team: A specialized SWAT team was formed to address denials from legacy claims. The team conducted deep root cause analysis.
Denial Root Causes Identified: Major issues such as bundling errors, failed medical necessity, and modifier misuse were uncovered.
CAPA Implementation: A comprehensive Corrective and Preventive Action (CAPA) plan was implemented to address systemic issues and ensure long-term resolution.
Outcomes
ED Coding Denials: Reduced from 18% to 8%
Urgent Care Denials: Reduced from 21% to 9%
Coding Accuracy: Improved from 80% to over 96%, leading to faster reimbursement and reduced administrative burden
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