Learn how consolidated oversight is helping to get ahead of clinical denials at Catholic Health Services from Meredith Simonetti, Vice President of Revenue Cycle.
How can you best position your team for clinical denials success?
Meredith Simonetti: “A great approach is to be proactive in the process of attacking denials before they happen. We utilize our physician advisors as well as our clinical appeals and clinical utilization management divisions to proactively approach denials while patients are still in-house.
“Under recent leadership changes, we've consolidated the oversight of both utilization management and denial management, which happens post-discharge under a single leadership structure that is supported by our CMO, as well as a single report structure that has been pushing the responsibility of identifying opportunities up front while physicians are doing their rounds, treating patients, and having the utilization nurses ping and query doctors to improve their documentation accuracy and completeness to support medical necessity.”
