Q&A: Setting expectations for denial management
Q: How can we develop clear duties and metrics for our denial management program?
A: Like a well-oiled machine, each component—or revenue cycle department—must function optimally for the entire revenue cycle to perform at its peak. Therefore, denial avoidance is a cross-functional, ongoing initiative. The departments with the most involvement are typically patient access, care management, patient financial services, HIM, and various clinical stakeholders.
Denial management and avoidance programs require full commitment and support from the entire organization. Consider the following keys to a successful program:
- A culture of continual improvement
- An assigned point person for program oversight and denial research
- Keeping abreast of new regulation
- Ongoing monitoring, trending, and reporting
- Openness and willingness to change
- Support from leadership
- Timely communication and feedback
How can you achieve the benefits of denial avoidance? Agility, clear processes, and reporting will go a long way to helping you meet your goals. The point is long-term, repeatable success, but there is often much that can be accomplished quickly. Identify quick hits and improvement opportunities that can be implemented within 30 days.
Reports and measures will help you focus the program and demonstrate results. Begin tracking and trending denial data, develop baseline metrics, and select key performance indicators.
Finally, even the most seamless processes need the right people to operate. Form a multidisciplinary denial avoidance team that meets frequently to address root causes and process breakdowns. Assign a team owner who will be responsible for the denials from each key area of the revenue cycle. Appoint a denial coordinator who will distribute data as well as monitor, research, and trend denials on a weekly basis.
For more information see The Contemporary Guide to Health Information Management.