For Providers

Revenue cycle management

Capitalize on our ability to exceed expectations for cash recoveries, coding accuracy, and denial reversals.

U.S. hospitals are struggling to maintain healthy operating margins.

Improving claims accuracy and focusing collections efforts on the claims and invoices that are most likely to be paid will help to offset losses.

The American Hospital Association has estimated that hospitals nationwide lost $54 billion in net income in 2021, largely due to the ripple effects of COVID-19.

Never has it been more important to address revenue cycle management (RCM) gaps and make strategic investments in collections and recovery.

Hiring more staff to collect payment and address denials is not necessarily the answer.

Sagility layers on EMR- and HIS-driven predictive analytics and machine learning to prioritize unpaid claims in terms of their probability of getting paid.

Using root-cause analysis on unpaid claims and applying intelligent automation to reminders, alerts, thresholds, validation, auto-population, etc. can improve claims accuracy and expedite payment.

A powerful combination of Sagility’s propensity-to-pay technology, automation, people, and processes has led to increases in collection rates, increases in collections within 90 days, improvements in speed of recovery, and reductions in cost and effort.

Dedicated RCM resources exceed expectations

With empowered, focused resources, we exceed client RCM expectations for financial clearance, coding accuracy, cash recoveries, and denial reversals. Sagility has recovered more than $1 billion in denied insurance payments for our provider clients by delivering end-to-end RCM services:

  • Eligibility verification
  • Prior authorization
  • Financial clearance support
  • Medical coding
  • Documentation and clinical reviews
  • Billing platform management
  • Denials management and appeals – clinical and administrative denials
  • Aged AR resolution, legacy AR winddown
  • Early-out/small balance claims resolution
  • Specialty AR management – workers compensation; motor vehicle accident; third-party liability
  • Payment posting
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How we do it

Our suite of services includes front-end patient access services; mid-cycle charge integrity, medical coding, and billing services; predictive analytics and automation; and back-end insurance claims resolution offerings, administrative and clinical denial appeals, and customer-driven, self-pay, early-out services.

The value of Sagility RCM services

The numbers speak for themselves.

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Accounts receivable

More than $6.9 billion in client accounts receivable are managed and $2.6 billion in cash recovered.

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We have processed more than 60 million hospital, physician, and DME claims.

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Denial reversal

We have reversed more than 8 million zero-paid denials, resulting in $950 million in recovered payments.

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Denial reversal on aged claims

Denial reversals and cash recovered on claims aged >1 year from discharge often cover cost of service.

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Cash recovery

Cash recoveries exceed client baselines by an average of +21%.

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Multi-source cash recovery

$3 billion in cash recovered, including $1.5 billion in denial reversals.

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Client satisfaction

100% of clients surveyed state that they would use our RCM services again.

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Our healthcare accreditations

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