Two changes in education approach are improving denials prevention at Westchester Medical Center Health Network, according to Vanessa Mackay, Network Vice President of Revenue Cycle.
What education approaches are helping you get ahead of denials?
Vanessa Mackay: 1) Continuous Learning. “Ongoing training is integral to denials management because the healthcare industry is forever changing, whether it be authorization requirements, benefits, or regulations related to CMS and medical necessity. We want to make sure that our staff is equipped to have (financial clearance) conversations, and that they understand what steps need to be taken at the point of registration to ensure that we have a clean registration and that a clean claim goes out the door.”
2) Feedback Loops. “Some of the things that we've been doing with the registration staff is developing a training program utilizing our own YouTube videos and a third-party learning module to address the key elements that Patient Accounting has shared with us as far as pain points when it comes to denials. There has been a focus on coordination of benefits, the importance of verifying benefits, and how to properly administer an ABN, an advanced beneficiary notification, such that the fields are filled out and the patient signs in the appropriate places.
"Within the registration QA module we implemented, the staff is responsible for working all their errors within the tool. And what we've seen with the staff having to go in and correct their errors is that registration accuracy continues to go up for those individuals, mitigating rework on the back end. So, whether it's a SIN number that needs to be corrected or a benefit order that needs to be reversed, those corrections are being made and it eliminates the work on the back end. The result has been a decrease in eligibility denials across the network.”
