Excessive Administrative Costs from Multi-Payer Billing Complexities

$0.2M–$0.4M annually through extended RN visit times, delayed reimbursement, and higher denial/appeal overhead for workers’ comp cases. • $0.3M–$0.5M annually from RN time diverted to rework, encounter delays, and underpayment or write‑offs for poorly documented Medicaid visits. • $0.3M–$0.6M annually from nurse time spent on administrative corrections and forgone revenue when services are documented in a way that cannot be billed under specific employer benefits.

Counselors access multiple payer portals, copy benefit details into Excel or local templates, and rely on personal notes about specific employer-plan idiosyncrasies to build estimates and payment plans. • Credentialing staff maintain multiple payer enrollment spreadsheets, track effective dates and network status manually, and cross-check against claims queues and denial reports by hand to identify when a credentialing gap is causing billing rejections. • Denials are queued in worklists and manually categorized; staff maintain spreadsheets of frequent Medicare denial reasons and corrective actions, with the Administrator monitoring performance via custom reports and Excel dashboards.