Research shows that 1 in 5 revenue cycle leaders feel their denial efforts "are not very effective." There are multiple reasons why, according to Willie Brown, Sentara Healthcare's VP of Revenue Cycle.
Why do you think so many revenue cycle leaders feel current denials management efforts are not very effective?
Willie Brown: "Measurement is hard. There are times when you think you are doing something well and then find out after you get your denial reports that you're not being as effective as you thought you were. And also recent payer behavior is a big component, given so many payer behavior changes these days. Also, the nature of the process. It often takes 30, 60, 90 days to determine if you received a denial. So just tracking that back to the actual service date, the bill date, and digging into related issues and then trending for those issues and communicating those findings. There also are times when standards are hard to come by. And so "what are you measuring yourself against?" a lot of times is the big question. Your payer mix has a lot to do with that (difficulty identifying comparative benchmarks). And also the staff time that it takes to process a claim and get to the root cause of the analysis and trending that back to the denial date, the bill date, can be difficult find."
