The situation
The migration left claims in two systems with inconsistent charge data. Nobody could say which balances were still collectible and which were past timely filing.
Modifier 59 usage on same-session arthroscopy procedures was inconsistent, producing bundling denials.
What we did
- 01
A full audit segmented the A/R into collectible, appealable and documented write-off pools.
- 02
The collectible pool was worked on contingency, highest value and nearest deadline first.
- 03
Modifier logic was rebuilt for same-session procedures, and the scrubber was updated to enforce it.
The result
- — $640K recovered, representing 41% of the collectible pool.
- — $210K written off with documentation, closing an audit exposure the practice had been carrying.
- — Bundling denials on arthroscopy claims fell by 72%.
"They were the first vendor willing to tell us which money was genuinely gone. That made the rest of the numbers believable."