Candice Powers, Chief Revenue Officer at USA Health, shares her top advice to revenue cycle leaders seeking a turnaround in denials management.
What tips would you offer to revenue cycle leaders seeking a denials management turnaround?
Candice Powers: “The first piece of advice that I have for revenue cycle leaders is to start today, no matter how large or how small of a denials problem that you have. Really dedicate some resources, as many as you can, to being able to appeal and analyze the denials information that's coming back into your shop.
"Secondly, make sure that you are appropriately attributing your denials to the root cause. So this can involve pre-services, registration, HIM, coding, billing, or it can include clinical areas. Get folks in your organization (on the front end) who are willing to help and involve them in the process.
"And then once you start seeing progress from (more successfully) appealing or making corrections in processes, you really need to celebrate that success. Everyone wants to be a part of a winning team, no matter how large or how small. So you will really drive engagement to get more folks involved in (additional denials projects).
"And then lastly, I would say it doesn't have to be overly complex. Get some templated letters. There are lots of places where you can borrow documents and resources to combat denials. It doesn't have to be an overly complex piece of technology. Of course, if you can invest in that technology, there are all kinds of technologies out there that can help in this realm. And if you have the bandwidth to do that, it really can alleviate some of the labor and some of, I think, what we find to be 'fear' around the resources that you have to dedicate to this.
"So get started today. Push back. If we don't push back, the situation is going to continue to worsen. It won't get better unless all of us are battling every denial, every time."
