Having RN insights strengthens denials root-cause analysis and ongoing training, explains Tammy Dumlao, Director of Revenue Cycle at Hawaii Health Systems Corporation
How can a nurse's perspective move the needle on denials?
Tammy Dumlao: “One of our facilities has a trending mechanism where they can track by payer issue, by payer, and the type of denials that are happening as well as two RNs in the business office. They work closely with our billers and collectors and trend those denials and work with the payers. They meet with them weekly, monthly––they just bug them. And they'll get to the point where they'll just escalate it to where there might be even legal action against the payer.
"They also find out things like if we need to educate our physicians on a documentation issue or process. They'll take it, they'll meet with the physician, show them what's happening, work on a process to prevent the denials in the future, and then they get back to those physicians to say, "Hey, it's working, or it's not working and [let's find the right way to] tweak it.”
