decisionhealth Newsletters, Part B News - 2013 Issue 8 (August)
Assess real damage from claims denials by looking at dollar loss value
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Article Overview
This article explains a denials-management approach for physician practices that goes beyond denial percentages and focuses on financial impact by code. It reviews analysis based on CMS claims data, highlights how utilization and payment amounts affect overall exposure, and discusses findings across multiple specialties. The piece is aimed at practice administrators, coders, and revenue cycle teams who want to understand which service lines may create the greatest financial risk from denials.
Why This Topic Matters
Looking only at denial rate can miss services that create substantial total revenue loss because they are billed frequently or carry higher allowed amounts. The article helps readers evaluate denial patterns in a way that better reflects real financial risk.
Article Sections
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Denials management
Introduces the denial-management perspective used in the article and frames the difference between denial percentage and broader financial exposure.
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Family practice/internal medicine
Summarizes the analysis for primary care specialties and discusses the general types of services that contribute most to financial risk.
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Cardiology
Reviews the cardiology portion of the analysis and the broader service categories examined for denial-related losses.
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Orthopedics
Covers the orthopedics findings and the major procedure categories included in the specialty review.
What You Will Learn
- How dollar loss value can provide a different view of denials than denial rate alone
- What types of specialties were included in the analysis
- How CMS claims data was used to frame denial-related financial risk
- Which broad service categories tend to drive higher exposure in the specialties reviewed
Who Should Read This
- Physician practice administrators
- Revenue cycle staff
- Medical coders
- Billing managers
- Compliance and denials-management teams
Codes Discussed
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Quick, Current, Complete - www.findacode.com