3 Ways One Leader Streamlines Denials Management

Denials aren't going anywhere, but streamlining how you manage them will help improve revenue cycle operations.

Revenue cycle leaders are still feeling the stress as regulatory burdens and never-ending denials are putting massive strains on revenue cycles.

Even if your front, middle, and back-end revenue cycle is a well-oiled machine, payers aren’t shy about throwing a wrench in things. In fact, it’s not uncommon for payers to have complicated, multi-tiered structures and rules that seem to always be changing, regardless of their contracts.

One leader has found that using a targeted approach for denials by creating teams that work by payer, establishing regular meetings, and data tracking can help tremendously in denials management.

Frank Cantrell, corporate director of revenue integrity at Penn Highlands Healthcare, says that each facility’s issues with denials can vary, but there are several constants that can be applied to improve denials management.

Here are three tips Cantrell says revenue cycle leaders can use to streamline denials management:

Know your contracts. Knowing not just the agreed upon payment rates but knowing the language and what rights you have makes a big difference. Many hospitals do not share contract language with those working the denials. This puts those staff members at a disadvantage when dealing with the payers.

Payer calls. Establish regular (we do monthly) calls with your payer representative. We provide a spreadsheet of claim issues—both payment and denial issues—prior to the call. This gives the payer time to review them and come to the meeting with answers. We put the burden back on the payer to tell us why the denial is valid and how to resolve it moving forward.

Track your data. We track all our denials by payer, reason, etc. so we can use this during contract negotiations. We provide this information to our managed care contracting director. If you have data the payer cannot refute, you have a greater chance of getting concessions on the new contract.