Healthcare orgs reflect on top vendors for denials management services

When working with vendors for denials management services, healthcare organizations are satisfied with their levels of expertise, overturn rates, and denial prevention, according to a KLAS report.

The KLAS Denials Management Services 2024 report shared how healthcare organizations feel about Aspirion, R1 RCM, Revecore, and Xsolis denials management offerings.

Revecore received the highest overall performance score of 95.0 on a 100-point scale, but there was limited data on this firm. All but one Revecore user was satisfied or highly satisfied with the vendor, and all customers would purchase the service again.

Users said the firm quickly handles appeals, provides thorough documentation, and manages difficult accounts while maintaining overturn rate expectations. Organizations also noted that staff have high levels of detail, continuity over time, and expertise. The dissatisfied user said the vendor missed expectations on working lower balance accounts.

Respondents working with Revecore reported high levels of strategic ability and partnership, highlighting the vendor’s responsiveness and collaboration. Most users mentioned the vendor’s denials prevention, with many noting the root-cause analyses and case studies that identify potential solutions and prevention measures.

Aspirion received a 92.1 for overall performance and welcomed the highest client satisfaction among fully rated firms. Users said the firm meets or exceeds expectations in overturn rates, contributing to high satisfaction and a sense of value with the services.

Organizations said Aspirion’s legal expertise was a core, differentiating strength, as staff use legal knowledge to improve the quality and effectiveness of appeals letters and provide client feedback. Some users noted execution misses as their engagement progressed due to inadequate staffing.

Users reported that the vendor has regular client conversations to discuss performance, trends, and strategies for improving organizational processes. Respondents also noted receiving specific education from the vendor through lunch-and-learn series, case study reviews, and appeal letter templates and examples.

R1 RCM received an overall performance score of 87.5, with clients reporting satisfaction with the firm’s efficiency and overturn rates. The vendor was recognized for its willingness to take on challenging denials, ability to manage large volumes, and timeliness in submitting appeals. Users noted the firm’s legal and clinical knowledge when crafting arguments and making appeals.

Some users were dissatisfied due to execution issues related to lacking resources or expertise, while others saw room for improvement in the firm’s consistency. However, R1 RCM clients felt the firm’s leadership is key to strong partnerships, indicating that it listens to clients and tailors services to meet their needs. Users were satisfied with the vendor’s assistance in improving processes and preventing denials.

Based on limited data, Xsolis received an 81.4 for overall performance. Around 60 percent of interview users reported high satisfaction, with the remaining users dissatisfied. Satisfied clients reported timely turnaround and some users praised the firm’s clinical expertise and judgement. Dissatisfied users said the firm is sometimes too slow or falls behind and noted inconsistent staff knowledge.

Across all denials management firms, clients reported wanting more trending data and more granularity around performance insights. Even satisfied users have asked for additional insights to help navigate the payer landscape and other operations. Firms are responding to these requests, but more proactive actions could help limit inconsistent reporting experiences, the KLAS report stated.