Q&A: Defining a denial management steering committee

Q: Do we need a steering committee for our denial management and avoidance programs? What would be the role of a steering committee?

A: The steering committee should use monitoring tools to reinforce accountability, performance issues, and trends. Senior executives should be kept in the loop and informed of the findings. The committee should provide oversight and accountability for performance improvement by using a standardized approach. In such an approach, when a denial category (e.g., coding rejection) exceeds a performance threshold, a research team or work group is formed. A member of the steering committee acts as the work group leader. The work group designs and implements an action plan to address controllable denials. Then the work group leader updates the steering committee regarding the progress of the investigation until the performance threshold is met or the issue resolved to the organization’s satisfaction. The steering committee will also advise work groups when to collaborate with other areas or departments to resolve high-priority issues.

The steering committee is responsible for acting on requests for changes in denial management reporting. The committee will need to weigh the costs and benefits associated with the request and all longterm reporting implications.

For more information, see The Contemporary Guide to Health Information Management.