Lyman notes that since the revenue center opened, denial rates have trended up, but he says this is a reflection of Advocate's ability to capture accurate data and not an indication of additional denials.
"The denial rate is actually going up because we can take all the transaction codes and standardize them across the organization so they will be classified correctly. Before those errors tended to be buried, and now we are uncovering them," he says.
Bringing Denials Data to Clinicians
Using data to educate clinicians about the role they play in generating denials is also vital to the organization's long-term financial health, Lyman says.
"A denial indicates that there has been a breakdown in the process someplace. We take those codes and map the denials to the responsible areas and present that group with the data to show where the breakdown is occurring, and then we put a corrective action in place. We are being proactive and going out to all the sites [with this data], and we are receiving a great deal of support around going after these denials."
For example, about 1% of Advocate's managed care claims currently result in a denial, Lyman says. "We are working those down and are doing a root cause analysis, and that program is going very well."