The situation
Concurrent review requirements varied by payer, and nobody owned the authorization calendar. Sessions were delivered against authorizations that had already lapsed.
Psychotherapy time units did not consistently match session documentation, producing downcoding and refund requests.
What we did
- 01
We built an authorization tracker keyed to units remaining and expiry date, with alerts before the last covered session.
- 02
Coders validated time-based units against documented session length before submission.
- 03
Telehealth place-of-service and modifier logic was standardized per payer.
- 04
The historical denial backlog was appealed with clinical documentation attached.
The result
- — Authorization-related denials fell 46% in four months.
- — $312K recovered from previously denied and unbilled sessions.
- — Downcoding disputes effectively eliminated after unit validation went live.
"Our clinicians stopped hearing about billing entirely, which is exactly what we wanted."