Featured Case Study
customer success
Interventional radiology group surfaces $1.86M in errors.
A six-physician, hospital-based interventional radiology practice finds costly coding and coverage gaps across $7.2M in billed claims, including medical necessity, modifier, diagnosis and units-of-service errors.
RESULTS
Proof in practice.
- $7.2M in total billed claims
- $1.86M in errors identified
- 6 physicians covered
Specialized care with complex reimbursement.
This hospital-based interventional radiology group performs high-value, procedure-driven services where payment depends on getting medical necessity, diagnosis coding, modifiers, units of service and bilateral requirements right.
With payer guidance changing frequently, even experienced billing teams can spend significant time interpreting coverage rules and correcting claims after the fact.
Medical necessity was only part of the problem.
The practice believed its denial rate was typical for interventional radiology. A closer look showed that medical necessity denials accounted for the majority of its coding problems.
At the same time, staff were manually tracking Medicare and Medicaid coverage determinations and commercial payer guidelines. Printed policy references had to be maintained for frequently performed services, and keeping them current took significant effort. Missed updates created additional opportunities for coding errors and lost revenue.
They also faced errors involving units of service, bilateral service validation, diagnosis validation, and modifier usage.
Current policy guidance goes into the claim-editing workflow.
Instead of relying on printed policies and manual searches, the billing team works with current Medicare, Medicaid, commercial, and proprietary medical necessity guidance as part of the claim-editing process.
Coders can open the relevant payer policy directly from the finding, giving them the context they need while they work the claim. That helps the team move faster across medical necessity, diagnosis validation, modifiers, bilateral services, and units of service without having to leave the workflow to search for answers.
With a broader view of coding and coverage gaps, the team can address more than medical necessity alone. It also catches errors tied to units of service, bilateral validation, diagnosis coding, and modifier usage.
That gives the practice a clearer path to lower denials and protect more revenue across the services it performs most often.
See Aptarro in action.
Get a live walkthrough tailored to your specialty and volume. No sales script — just the platform, doing its thing.
Request a demo20+ EHR/PM integrations · A network that never stops learning