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Tip: Three ways to start using physicians in a denial program

Patient Access Weekly Advisor, April 16, 2008

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Here are three options to consider if you decide to make physician participation a regular part of your denial management program:

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, it should consider using volunteer physician advisors.

Option #3: Require denial management services in bylaws. “Many physicians don’t have an expanded sense of duty when it comes to administrative tasks like denial management,” says Kentucky-based consultant Linda Peeno. So it may be difficult to get physicians to volunteer, especially if they already resist attending partnership meetings or taking calls in the ED.

To avoid spending more money, you can also amend your medical staff bylaws, joint venture agreements, or other documents to require denial management services as an obligation of membership.

Editor’s note: This tip is from Revenue Cycle Management: A Best Practices Toolkit. To learn more about this book, click here.

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