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Tip of the week: Three ways to get started using physicians in a denial program

Case Management Weekly, August 17, 2005

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If you decide to make physician participation an integral or more regular part of your denial management program, try these two options:

• Option #1: Pay a physician for denial management. Your organization may be able to hire a physician advisor to work on denial management who wouldn't have any other administrative or clinical responsibilities. The physician advisor could work on a contingency basis - that is, his or her fee would be based on the amount of insurance reimbursement he or she facilitates. Another option is to add this function to the job description of a physician already involved in administration, such as your medical director.
• Option #2: Start a volunteer program. If your hospital, medical group, or provider organization determines that it wouldn't be cost effective to pay physicians to conduct denial management, consider using volunteer physician advisors. Robert Barber, DHA, director of payer contract compliance at Carolinas Health System, says his organization uses volunteers from the attending physician's department to help the attending physician prepare to talk to the plan's medical director and write a letter to accompany the initial appeal to the plan. Although the attending physician consults the volunteer, he or she's still responsible for calling the plan.

Source: Patient Financial Services Advisor, June 2005, HCPro, Inc.

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