BC Advantage - 2009 Issue 12
Enhance Net Revenue by Improving Your Denial Management Program
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Article Overview
This article discusses how hospitals can strengthen denial management to reduce revenue loss and improve net revenue. It is aimed at revenue cycle, patient accounting, case management, HIM, and related operational leaders, and it outlines broad guidance on denial tracking, reporting, prevention, appeals support, team structure, benchmarking, and communication practices.
Why This Topic Matters
Denials can create significant administrative burden and financial leakage. Understanding the main components of a structured denial management program can help organizations assess current practices and identify areas for revenue cycle improvement.
Article Sections
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Challenges
Introduces common operational and organizational obstacles hospitals face in denial management. Describes the lack of standardized approaches, data sources used, and the need for multidisciplinary coordination.
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Insights
Presents broad recommendations for improving denial management across several functional areas. Covers infrastructure, recording, reporting, prevention, and appeals.
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Infrastructure
Discusses team structure, roles, meeting cadence, objectives, performance measures, benchmarking, and communication planning for a denial management effort.
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Recording Denials
Focuses on establishing centralized tracking, organizing denial information, assigning responsibility, and aligning denial and write-off records.
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Reporting Denials
Addresses reporting needs for denial activity and related write-offs, along with performance monitoring and goal setting.
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Preventing Denials
Covers training, workflow readiness, payer requirements, filing deadlines, and contract-related approaches intended to reduce preventable denials.
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Appealing Denials
Discusses support resources, access to payer and regulatory information, and use of external assistance in appeal activities.
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Summary
Wraps up the article by reiterating the value of process improvement and gap analysis in denial management.
What You Will Learn
- The major components of a hospital denial management program
- How organizations can organize teams and responsibilities around denials
- Common areas involved in denial tracking and reporting
- General approaches used to reduce preventable denials
- Broad considerations for supporting denial appeals
- How benchmarking and communication fit into denial management
Who Should Read This
- Hospital revenue cycle leaders
- Patient accounting staff
- Patient access staff
- Case management teams
- Health information management professionals
- Revenue integrity teams
- Denial management staff
- Healthcare consultants
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