Consider a three-pronged approach to reduce clinical denials, says Ashley Holmes, Director of Revenue Cycle at Bassett Healthcare Network and Bassett Medical Center.
What three areas should underpin any clinical denials improvement program?
Ashley Holmes: “Improving clinical denials starts with transparency, making sure that those clinical operational key stakeholders understand the revenue cycle metrics and the data that we're looking at to measure performance, and making sure that they know the area of focus where they have an impact and that they understand that "revenue cycle lingo."
"And then the next area is really looking at improvement opportunities from a curiosity standpoint. No one wants to hear that their department is doing a bad job or that they are doing something wrong. So, by taking the denial trend and approaching it with curiosity, like, "Help me understand your workflow, help me understand your process and how this gets instituted within this department." This mindset really gets clinicians to be a part of the discovery of the root cause as well as a part of the implementation of a fix.
"And then it's a matter of consistency: You follow through with the transparency of those key metrics so that they can see the trends of where they started and how the improvement is going, and making sure that support is continuing along the way."
