Chicago, IL - December 5
Summary
Claims denials represent not only uncollected revenue, but also hidden expenses that erode a provider's bottom line due to required rework. Consequently, the importance of measurable, predictable, and sustainable denials prevention and management systems has never been greater. Even in the post-reform era (when the ability of insurance companies to deny, reject, or delay claims would be seemingly constrained), unpaid or underpaid claims are a constant challenge for healthcare providers. This seminar guides participants through the planning, pitfalls, and successes in designing a best practice denials system that is consistent with today's complex reimbursement environment.
After this seminar, you'll be able to:
- Apply Lean Six Sigma principles to analyze the prevalence of denials and discrepancies, and identify their root causes.
- Use business process management techniques to create sustainable denials-prevention workflows that are measurable, predictable, and sustainable.
- Develop a denials resource center that focuses on the prevention, detection, and correction of denials, rejections, and payment discrepancies.
- Review language in managed care contracts to minimize denials, assess the impact of healthcare reform on payer contracts, and address problem areas in managed care contract terms.
Level: Intermediate
Prerequisites
General knowledge of revenue cycle work flows and processes
Tools and Takeaways
- Framework for creating a denials resource center
- List of KPIs designed to improve internal denials-control processes and managed care contracts
Recommended for:
Those who need to establish an understanding of their organization's chargemaster review process. This includes reimbursement managers, patient financial service managers, business office managers, medical record personnel, compliance officers, controllers, chief financial officers, department heads, and all others responsible for maintaining the chargemaster.
Faculty
David C. Hammer
Partner, Accenture
Continuing education: 7 CPE credits; 6 hours Category II (non-ACHE) credit
What You Need to Know About HFMA's Seminars
Publication Date: Friday, July 20, 2012