HOME » Convergent Makes Fast Work Out of Workers’ Comp Case Study




Many hospitals face workers’ compensation claim denials without the expertise or resources necessary to successfully dispute the denials.

Convergent’s attorney-driven approach has proved effective in case after case in obtain payment on previously denied workers’ compensation claims.

A hospital in Davenport, Florida, placed an aged claim with Convergent that had been denied as not compensable and submitted to the patient’s Health Insurance carrier by the client. Convergent scrutinized medical records and crafted an appeal to dispute the denial with the Workers’ Compensation carrier. Convergent was able to prove that the incident was work related, and the Workers’ Compensation carrier issued payment in the amount of $32,791.71 on this bill.

A hospital in Charlotte, North Carolina, had a claim denied by Department of Labor (DOL) for no authorization. Using their knowledge of DOL’s specific guidelines for coding and document submission, Convergent was able to get DOL to approve the authorization and overturn the denial. After repeated follow-up with DOL, they issued a payment in the amount of $41,269.92.

A hospital in Charlotte, North Carolina, had a Workers’ Compensation carrier deny receipt of their initial bill. Convergent submitted this bill to the Workers’ Compensation carrier and a payment in the amount of $5,947.23 was issued. Convergent then recognized this bill was underpaid per the contract and disputed the underpayment with the carrier. Convergent was able to get the carrier to issue additional payment in the amount of $30,915.00.

A Pennsylvania hospital billed an account under current DRG code 387. Understanding that the Pennsylvania Fee Schedule only recognizes DRG codes from 1994, Convergent cross-walked the DRG code billed by the hospital to the matching code from 1994. After recommending that this code be revised to match the Fee Schedule, the hospital updated the UB and a payment was issued in the amount of $101,986.80.