Q&A: Building a denials database

October 16, 2017
Medicare Web

Q. What methods should my facility consider when building a denials database?

A. There are many methods to create and maintain a denials database. Many practice or facility computer systems have an out-of-the-box or add-on denials management module. When such programs are not available or do not meet your needs, there are many software vendors that offer sophisticated denials management programs. If denials management software is not in the budget, a functional database can be created with Microsoft Access® or in an Excel® spreadsheet. The latter two options, however, will require more manual work but can be equally effective.

Whatever the method, there are a number of essential components you should capture to effectively manage your denials. These include all zero payments, underpayments, and claim rejections. In addition, for each denial, it is important to track them by the payer, RARC/CARC code, monetary consequence of the denial, whether it was technical or clinical, who was the ordering or performing physician, the HCPCS/CPT® code, and DRG code. It’s also important to track the date of the initial denials along with the date of the final denials.

For more information, see The Denials Management Training Handbook.

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