Multi-disciplinary performance improvement team decreases clinical denials by 52%

Denials Management

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.

Establishing a multidisciplinary performance improvement team resulted in a 52% decrease in denials,” said Theresa Brandon, Managing Director with Novia Strategies. “The collaboration of leaders set an example for staff members on the benefits of engaging other departments to find permanent solutions for recurring problems.”

The approach

With support from the system’s executives to prioritize this initiative, we collaborated with our client’s leadership to develop a Multi-Disciplinary Performance Improvement team.

  • Assembled a multi-disciplinary team: Involving key stakeholders from Care Management, Patient Access, Patient Finance, Coding, Medical Records and Compliance enabled the team to take an integrated approach to problem-solving.
  • Developed ground rules: Agreeing upon core tenets for discussion items ensured productive meetings. Discussion items were expected to be recurring in nature, substantial in financial impact, and required collaboration of three or more team members for resolution.
  • Closed the loop on denials: Bringing denials to the group for collaborative discussion and specific assignment of follow-up items to team members led to root-cause identification and actionable next steps.
  • Education and communication: Researching and discussing underlying causes provided clarity and positioned team leaders to identify and propose long-term solutions to the appropriate stakeholders.

The results

Case Study Results

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