Reading Time: 6 minutes
Financial Impact: Evidence provided to negotiate a $1M risk-sharing savings

After signing a Value-Based Care (VBC) contract with Anthem, a statewide OB practice was blindsided by a $1.3 million downside risk penalty, with no way to validate the payer’s claims. Anthem presented its cost calculations as final only in summary form, likely assuming the practice lacked the tools to analyze the data. Without RevOps Health, the practice would have been forced to either accept the charge or engage in an unstructured, “he said, she said” debate. Using advanced search capabilities and financial modeling, they extracted visit data, applied payer exclusions, and benchmarked costs against medical inflation. Armed with clear evidence, the practice countered Anthem’s assertions, proving that cost increases were primarily facility-driven and outside their control—leading to a major reduction in financial liability.

Reading Time: 5 minutes
Financial Impact: Recovered $1.5 million in denied claims.

A healthcare provider identified and resolved a surge in preauthorization mismatch denials. Analysis with RevOps data visualization tools enabled cross-functional collaboration and systemic corrections, improving workflows and recovering $1.5 million.

Reading Time: 5 minutes
Financial Impact: Recovered $1 million in underpayments.

A healthcare organization uncovered over $1 million in underpayments caused by a payer misapplying reimbursement rates for eating disorder claims. OpsRadar provided evidence for successful payer negotiations and established annual audit protocols to ensure compliance with updated rates.

Reading Time: 3 minutes 
Financial Impact: Recovered $85,260 in unpaid claims.

An urgent care network struggled to reconcile a clean billing report with no denials as provided by their biller on COVID-19 testing and revenue that fell short of expectations for the business line.

Reading Time: 3 minutes 
Financial Impact: Recovered $1M in patient collections

A dual-specialty clinic addressed a $1M revenue shortfall by identifying missed patient payments at check-in. OpsRadar revealed workflow gaps caused by staff turnover, prompting standardized processes and training that drove immediate improvements in patient collections.

Reading Time: 3 minutes 
Financial Impact: Avoided $15,000 in monthly losses and prevented $540,000 over three years. 

A mid-sized pulmonology practice identified recurring losses due to non-reimbursed diagnostic sleep tests. Using OpsRadar, the team discovered that their preferred test had a 100% denial rate, prompting an immediate switch to an alternative test with near-universal reimbursement. 

Reading Time: 3 minutes
Operational Impact: Supported data-driven decisions for clinic consolidation.

A primary care clinic used OpsRadar to analyze patient overlap between two locations, guiding consolidation decisions that minimized disruptions and maximized efficiency.

Reading Time: 3 minutes
Financial Impact: Avoided $45,000 in unnecessary vendor fees.

An MSO evaluated a third-party vendor for pre-authorization software and found the fees would exceed potential financial benefits. Using RevOps analytics, the MSO refined internal processes, avoided unprofitable vendor contracts, and reinforced data driven decision-making.

Reading Time: 4 minutes
Financial Impact: Improved contracted rates and ensured payer compliance with new agreements.

Two independent practices used OpsRadar to secure higher reimbursement rates by presenting data-driven evidence of underpayments. Post-contract, automated monitoring ensured payers adhered to the new rates, streamlining negotiations and enforcing accountability.

Reading Time: 2 minutes
Financial Impact: Recovered millions in unsubmitted claims and prevented further financial losses.

A community health center struggling with razor-thin margins used OpsRadar to uncover hidden inefficiencies in its billing operations, recovering millions in unsubmitted claims. By identifying underperformance, retraining staff, and prioritizing high-value claims, the CHC achieved financial stability and implemented sustainable billing processes.