Q&A: Setting expectations for denial management
in Revenue Cycle Advisor.
Q: How can we develop clear expectations for our denial management program?
A: Denial avoidance is a cross-functional, ongoing initiative. The departments with the most involvement are typically patient access, care management, patient financial services, HIM, and various clinical stakeholders.
Denial management and avoidance teams require full commitment and support from the entire organization as well as the following:
- A culture of continual improvement
- An assigned point person for program oversight and denial research
- Ongoing education and flow of information related to new regulations and changes in reimbursement rules
- Monitoring, trending, and reporting on program focus areas and productivity concerns
- Timely communication and feedback related to the data being monitored
- Openness and willingness to change
How can you achieve the benefits of denial avoidance? Agility, clear processes, and reporting will go a long way to helping you meet your goals. The point is long-term, repeatable success, but there is often much that can be accomplished quickly. Identify quick hits and improvement opportunities that can be implemented within 30 days.
Reports and measures will help you focus the program and demonstrate results. Begin tracking and trending denial data, develop baseline metrics, and select key performance indicators.
Finally, even the most seamless processes need the right people to operate. Form a multidisciplinary denial avoidance team that meets frequently to address root causes and process breakdowns. Assign a team owner who will be responsible for the denials from each area of the revenue cycle. Appoint a denial coordinator who will distribute data as well as monitor, research, and trend denials on a weekly basis.
Editor’s note: This article originally appeared in Revenue Cycle Advisor. For more information see The Contemporary Guide to Health Information Management. For more information on CDI’s role in the denials management process, read the September/October 2017 edition of the CDI Journal.