Focus on the denials that are the most likely to be successfully appealed.
Crystal Ewing, Senior Business Analyst, Manager of Regulatory Strategy, ZirMed: To effectively manage denials, focus your efforts on the denials that have the highest likelihood of being appealed successfully and that have the greatest impact on your organizational performance. Then, as you gain insight into payer-specific denial trends and outcomes, tailor your approach by payer — you can even segment the workflow by payer or claim type if the workload supports that decision.
This model of prioritization can also help you manage the transition to ICD-10. Your staff likely won't be able to rework every denial in the weeks following go-live — they'll appreciate knowing which denials to focus on, and which to "let slide."
If you would like to share your RCM best practices, please email Carrie Pallardy at cpallardy@beckershealthcare.com to be featured in the "RCM tip of the day" series.