Revenue Cycle

Q: I need to put together our facility's goals to present at our first denial-management meeting. Do you have any suggestions on how to organize everything?

Patient Financial Services Weekly Advisor, May 28, 2004

A: Jill A. Frye, RN, BSN, MSA, director of access management services at Rex Healthcare in Raleigh, NC, spoke last week during the Denials Management Summit in Orlando, FL, on the very subject. Here's what she had to say:

Process improvement has a direct link to your facility's culture. Successful denial management requires the expertise of many disciplines, and changing culture to embrace the talents of each department takes time, she said. Be sure to meet routinely to keep up motivation and accountability.

At Rex Healthcare, Frye broke down her goals into three critical functions with corresponding key issues.

1. Denial prevention. Organize an ongoing action team to

  • improve data gathering during scheduling
  • develop and enforce a standardized patient-registration process
  • report failed bill and claim issues and expect action by the accountable department
  • overhaul the chargemaster process

    2. Denial coordination. Have parameters set to

  • establish shared revenue-cycle leadership
  • define denial language (rejection v. revenue loss v. underpayment)
  • define how you will report (make it automated)
  • define who is accountable in each department

    3. Denial recovery. Be sure to

  • define who will be responsible for reporting what and how often
  • define who will be responsible for reviewing reports and how often
  • establish a denial recovery unit
  • establish write-off rules
  • identify rejection and revenue loss trends

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