Denial management review team decreases annual write-offs by $650,000

Denials Management Review Team

The client

This three-hospital system wanted to reduce denials and become a top performer in denial prevention and resolution by combining the expertise of clinical and non-clinical staff.

The challenge

To create a proactive denial management process that would result in decreased denials, our client needed to address their historical data capture challenges and decentralized approach to denial resolution.

Redefining the roles of billing team members, and maximizing use of technology were essential to making this project a success,” said Theresa Brandon, Managing Director with Novia Strategies. “These initiatives enabled our client to validate financial collection efforts of the team and save $650,000 in annual recurring savings.”

The approach

Partnering with key Patient Financial Services leaders and the client’s newly established Performance Improvement Team enabled us to identify and address challenges with the capture and assimilation of information.

  • Created new denial management review team: Realigning billing team members created a new denial management review team charged with performing the initial reviews of payer denials and resolving or assigning to the appropriate work queue. Training and education ensured consistent distribution of denials to the work queues.
  • Optimized technology: Expanding existing technology systems created distinct work queues for resolution of complex denials. Tracking and aging items by work queue provided visibility to ensure timely resolution, avoiding losses for untimely responses.
  • Championed inter-departmental alignment: Aligning denial work queues with members of the
    Performance Improvement Team provided timely examples of denials for root cause analysis at Performance Improvement Team meetings.
  • Improved data collection and integrity: Expanding write-off codes improved the integrity of data collection and reporting. The expanded codes provided more specificity, allowing the client to identify more improvement opportunities.

The results

Case Study Results

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