Strategies to Prevent Claims Denials

This course defines claims denial management and explains the impact of claims denials on hospitals. It highlights the benefits to hospitals of managing claims denials effectively and describes how claims denials can be managed both before and after denials take place. The course describes types of denials and discusses key strategies for preventing and correcting some common causes of denials.

Estimated course completion time: 1 hour

Learning Objectives:

After this program you will be able to:

• Define claims denial management
• Recognize the main functions of a claims denial management program
• Recognize the benefits of claims denial management
• Define the term “denial”
• Identify six types of denials: technical denials, medical denials, partial payments, claim suspensions, discrepancies, and late payments
• Name some of the reasons why hospitals get technical and medical denials
• Identify some ways to prevent and correct technical and medical denials
• Recognize how discrepancies and late payments affect a hospital’s bottom line
• List some ways to prevent and pursue discrepancies and late payments
• Recognize why hospitals should focus on preventing claims denials
• Recognize how hospitals can measure and analyze denial data to identify the root causes of denials
• Define the term “revenue cycle”
• Summarize the various strategies hospitals use to proactively reduce denials

Course Outline:

01. Section 1: Getting Oriented

• Lesson 1: Getting Started
• Lesson 2: Course Overview

02. Section 2: Benefits of Managing Claims Denials

• Lesson 1: Overview
• Lesson 2: Benefits
• Lesson 3: Medical Review
• Lesson 4: Managing Claims Denials
• Lesson 5: Section Review

03. Section 3: Types of Denials

• Lesson 1: Overview
• Lesson 2: Technical Denials
• Lesson 3: Claims Suspensions
• Lesson 4: Medical Denials
• Lesson 5: Discrepancies
• Lesson 6: Late Payments
• Lesson 7: Section Review

04. Section 4: Proactive Strategies to Prevent Denials

• Lesson 1: Overview
• Lesson 2: Denials Management
• Lesson 3: Step 1 – Measure
• Lesson 4: Step 2 – Identify and Analyze
• Lesson 5: Step 3 – Improve
• Lesson 6: Step 4 – Maintain the Improvement

05. Course Review

• Lesson 1: Section Review

General Program Information