A large regional health system had a problem familiar to most revenue cycle leaders, a sizable book of denied, aged accounts that their internal prioritization logic had effectively written off. These accounts were buried under a rules-based workqueue that couldn’t distinguish between denials worth appealing and those that weren’t. The result was $43M in open balances sitting at 91+ days, unworked and deprioritized, while outsourced vendors had no clear signal on where to focus. This is the cost of working denials without Payments Intelligence.
The Problem With Legacy Denials Prioritization
Most denial workqueues are still built on static rules based on account age, payer or balance thresholds. These rules treat all denials within a tier the same. But in practice, within any cohort of aged denied accounts, a small percentage carries the majority of recoverable value. Legacy systems can’t see that. Revenue cycle teams end up working the queue top-to-bottom. They spend time on low-yield accounts and can easily miss high-yield ones.
When the follow-up work is outsourced, the problem compounds. The health system loses visibility; the vendor is working blind and aged AR just keeps aging.
What Sift’s Payments Intelligence Changed
The health system deployed RevProtect Payments Intelligence across their aged denial population — 4,245 accounts representing $139M in original gross charges and $43M in open balances, all 91+ days outstanding.
RevProtect’s Propensity-to-Overturn models scored each account based on historical payments data (not rules, not age, not balance alone). The scores told both the health system and their outsourced vendors which accounts were actually worth working, and in what order.
Of the 4,245 accounts, 2,179 (51%) were flagged as high priority for denial recovery. The vendors worked those accounts first.
Five months later:
- $13M recovered from accounts previously deprioritized and unworked
- 98% of overturned dollars came from the top 50% of RevProtect-scored accounts
- A/R over 90 days reduced by 40%
- An additional 1,550 high-yield accounts were identified mid-engagement for immediate follow-up
The scoring didn’t just surface recoverable value but also gave the health system a new way to direct and hold accountable its outsourced vendors. A 30% recovery rate on a $43M book of aged, deprioritized denials isn’t a rounding error. It’s cash that the health system had functionally written off.
If your current prioritization logic can’t tell you which 50% of your denied accounts hold 98% of your recoverable value, how much reimbursement are you missing?
Learn more about Sift’s post-bill recovery solution.
Read about how Sift helps health systems add payments intelligence into vendor outsourcing decisions.
