Q&A: Measuring productivity for denials specialists

Q: How do you measure productivity for a denials specialist? Do you measure the number of appeals per day, per week, or per month? Are there any other tasks that affect this metric?

A: The number of appeals a denials specialist can get through in a day depends on a couple of factors, namely the length of the admission being denied and the depth of the denial. Generally, a straightforward DRG appeal with a moderate length of stay takes roughly an hour to an hour and a half. Appeals beyond the first level usually take about 30 minutes to write since you’ve already done the deep dive appeal on the first level.

When thinking about productivity for denials specialists, it’s helpful to evaluate it in conjunction with the quality of their appeal letter itself. While a one to two-page appeal should only take an hour or hour and a half, an appeal that involves a detailed persuasive argument over six to eight pages will necessarily take longer to write.

While some measure of productivity monitoring and benchmarking is helpful, it should likely take a backseat to other measures such as overturn rate, educational efforts to prevent denials, the quality of the appeals written, and other aspects of a denials specialist role.

Editor’s note: This question and answer were adapted from a thread on the ACDIS Forum. To learn more about participating on the Forum, click here.