Denials Management

Hospitals can gain significant revenue by implementing an effective utilization review program.

As evolving market trends shape healthcare payment, providers continue to face real-world, day-to-day challenges that contribute to unpaid claims, unnecessary denials, workflow inefficiencies, and rework. By implementing the recommendations outlined here, providers can obtain the necessary visibility and control over their claims payment processes that can help them not only sustain a healthy revenue cycle,…

Each year, leaders at ProMedica set a 3 percent cost-reduction goal, which they believe is achievable and still has a significant impact on the bottom line.

With pressure on providers to prove medical necessity and validate code assignments, business office staff must provide more patient information, such as medical records, putting greater demands on their time. Yale New Haven Health addressed this problem by implementing a centralized protected health information (PHI) disclosure management system.

The Hand & Wrist Center of Houston is a surgical practice that is using effectively using a combination of technology and service to significantly improve its revenue cycle.

Using technology to prevent denied claims and providing patients with price transparency are just two ways healthcare organizations can improve their revenue cycle performance.

Hospitals are deploying physician advisors to bolster the revenue cycle in a variety of areas, including clinical documentation, denials prevention, utilization review, and value analysis.

Six steps can help revenue cycle leaders manage health plan changes effectively.

Developing engagement across a hospital or health system encourages collaboration and problem solving on costly claim denials.

Denial prevention efforts should focus upstream in the revenue cycle, starting with patient status and continuing through documentation practices, coding, CDI, utilization review, and charge capture.