As payers continue issuing denials at high rates, health systems are shifting their focus inward, emphasizing staff training, clinical integration, and contract negotiations to curb denial rates.
While it is easy to blame payer algorithms for rising denial rates, health systems must take action on the factors within their own control. By proactively addressing internal knowledge gaps and ineffective workflows, revenue cycle leaders can build a stronger defense against preventable revenue leakage.
See the infographic below for some quick tips on rethinking denial management.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Revenue cycle leaders are prioritizing staff training to close internal deficiencies in registration, authorization, and coding that cause preventable upstream denials.
Organizations are restructuring their org charts to place case management and physician advisors directly under revenue cycle leadership, bringing a united clinical front to the fight against medical necessity denials.
Contracting strategies are being used to force payers to issue medical necessity denials concurrently while the patient is still in the hospital, rather than fighting an expensive, retroactive battle after discharge.