Over two years, NYC Health + Hospitals cut the rate of claims denials in half, saving the system $50 million in one fiscal year
NEW YORK, April 8, 2025 /PRNewswire-PRWeb/ -- NYC Health + Hospitals today announced it received the 2024 Richard L. Doyle Award for Innovation and Leadership in Healthcare from MCG Health, which provides clinical guidance software to healthcare organizations. By using MCG solutions and creating new internal processes, NYC Health + Hospitals cut the rate of health insurance claims denials for inpatient stays in half over two years, saving the system $50 million in one fiscal year. NYC Health + Hospitals is the only healthcare provider to win the award for 2024. Health system leadership will accept the award and present their award-winning project at MCG's Client Forum in May. As part of the award, the health system will receive a $10,000 prize, which will support further growth and development of the Utilization Management team.
"It is an honor for our health system to win the Award for Innovation and Leadership in Healthcare from MCG Health, a leader in clinical guidance software," said NYC Health + Hospitals Medical Director of Utilization Management Joshua Moskovitz, MD, MPH, MBA, FACEP. "This achievement is reflective of the dedication and expertise of our team members across the eleven acute care hospitals and central office. Collectively, their hard work and commitment made this possible, further reinforcing the exceptional care we provide every day. Thank you to everyone whose innovation, passion, and unwavering dedication led to this accomplishment."
"We are honored to receive this award recognizing our efforts to reduce medical necessity denials," said NYC Health + Hospitals Chief Revenue Officer Marji Karlin, MBA. "This achievement reflects our ongoing commitment to ensuring patients receive timely access to the care they need while maintaining financial stewardship. This award is a testament to the hard work and collaboration of our teams across departments and facilities who have strived to improve processes, enhance documentation accuracy, and advocate for our patients."
"Across the nation, hospitals and health systems face financial pressures from health insurers denying claims for care that has already been provided," said NYC Health + Hospitals Senior Assistant Vice President of Quality and Safety David Silvestri, MD, MBA, MHS. "At NYC Health + Hospitals, our success reducing denials means we can continue to grow the lifesaving services we provide every day to New Yorkers, without exception. We are grateful to our partners at MCG for recognizing these efforts, and for the countless teams and individuals across our health system who have been part of this important success story."
MCG Health President and CEO, Jon Shreve stated, "We applaud NYC Health + Hospitals for their remarkable achievement using evidence-based guidance and technology to streamline care and reduce unnecessary denials. This is a reflection of their commitment to innovation and teamwork as they advance patient-centered healthcare solutions."
The health system improved health insurance claims for inpatient stays in several ways:
- Disease-specific best practices: After identifying the diseases with the highest rates of claims denials, including chest pain, appendicitis, sepsis, and cholecystitis, the project team created disease-specific alerts to improve clinical documentation.
- Tools to streamline documentation: templates were created to help physicians and care managers improve documentation of medical necessity of the services provided by capturing distinct data points demonstrating the severity of illness and level of care needs.
- Staff training: The project team provided full-day retreats for our hospitals providing education and training to clinical departments (Emergency Medicine, Internal Medicine, Surgery), Case Management, Finance, and hospital leadership.
- Friendly competition: As the project progressed, the team presented site-level data on efficiency and outcomes, which encouraged other sites to participate.
Every year, MCG Health recognizes two healthcare organizations, one payer and one provider, with the Richard L. Doyle Award for Innovation and Leadership in Healthcare. The award is named after Dr. Richard L. Doyle, who was one of the early pioneers of evidence-based clinical guidelines. Receiving the award reflects the highest commitment to best practices, measurable outcomes in healthcare quality and cost-effectiveness, and transformational initiatives. Award nominations are evaluated by an independent panel of healthcare industry experts who are not employed by MCG.
About NYC Health + Hospitals
NYC Health + Hospitals is the largest municipal health care system in the nation serving more than a million New Yorkers annually in more than 70 patient care locations across the city's five boroughs. A robust network of outpatient, neighborhood-based primary and specialty care centers anchors care coordination with the system's trauma centers, nursing homes, post-acute care centers, home care agency, and MetroPlus health plan—all supported by 11 essential hospitals. Its diverse workforce of more than 43,000 employees is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible. For more information, visit http://www.nychealthandhospitals.org and stay connected on Facebook, Twitter, Instagram and LinkedIn.
About MCG Health
MCG, part of the Hearst Health network, provides unbiased clinical guidance that gives healthcare organizations confidence in delivering patient-centered care. MCG's artificial intelligence and technology, infused with clinical expertise, enable its clients to prioritize and simplify their work. MCG's world-class customer service ensures its clients maximize the benefits of licensing MCG solutions – demonstrating improved clinical and financial outcomes. For more information visit http://www.mcg.com.
About Hearst Health
The mission of Hearst Health is to guide healthcare organizations by delivering essential intelligence and software that improve the quality, safety, and efficiency of care. Hearst Health has been innovating with care for more than 40 years, with a commitment to making a lasting positive impact on health. The Hearst Health companies — FDB, Homecare Homebase, MCG, MHK, QGenda, and Zynx Health — elevate care by informing and empowering participants across the health journey. To learn more, visit http://www.hearst.com/hearst-health and follow @Hearst Health on LinkedIn.
Media Contact
Arri Stewart, MCG Health, (206) 389-5405, [email protected], https://www.mcg.com/
SOURCE MCG Health
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