When it comes to managing denials, revenue cycle management leaders say it's important to focus on the ones that can be controlled, have an engaged team and stop denials at the source.
Three tips revenue cycle management leaders shared with Becker's:
Chris Healy, Revenue Cycle Director at Cottage Hospital (Woodsville, N.H.).
1. Report
2. Sort
3. Review the worst offenders
4. Attack ones you can control
5. Rinse and repeat
In my experience, the most effective approach is to sift through the data to look for ones you can fix and target a few of them at a time. Identify the issue, determine solutions, then communicate that to the relevant staff members. Follow up on the process for a few reporting cycles to ensure the fix is taking hold, highlight the reduction in denials and celebrate the successes to show the returns on everyone's efforts. Then rerun your denials volumes and pick a few new, juicy targets to shine your spotlight on. There can be a lot of noise in denials data, many payer issues that are difficult to influence. Don't get bogged down with those; build momentum by focusing on ones that you actually can fix. There should be plenty of those to keep you busy and make all involved feel invested and that they are making a difference.
Amy Crawford, Vice President of Revenue Cycle at North Kansas City Hospital (Mo.).
It's so important to have an engaged multidisciplinary team in the denials review process. Even for organizations that can't commit dedicated resources to denials efforts, it's essential to have stakeholders from the key revenue cycle, managed care and operations areas engaged to identify denial root causes and workflow change options to prevent future denials. The team should meet regularly and discuss any wins, findings, upcoming policy impacts, vendor partnerships or gaps that pertain to the organization's denials efforts — just keeping the conversation going. Denials management has to be intentional and consistent or it can get lost in the "noise" of all the other competing priorities within an organization.
Caroline Balfour, Vice President of Revenue Cycle at Huntington Hospital (Pasadena, Calif.).
Managing denials comes down to stopping them at the source. We use data and interdepartmental collaboration to identify problem areas in tandem with creating very specific action plans to eliminate the root causes. Tracking and trending is crucial.