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Q: We would like to put together a denial management task force at our facility. What’s the best way to get started? Who should be involved?

Patient Financial Services Weekly Advisor, July 16, 2004

A: Task forces are the way of the future for revenue cycle processes, and the group should be a cross section of people who are involved in it. Resolution and management of denials should be the focus of every member in order to capture reimbursement that is legitimately owed to a facility.

Upon formation of the team, a purpose statement and a mission statement should be created. Both statements should be concise and specific to what your team intends to accomplish. Your statement of purpose and your mission should be on every publication that is produced by your team, such as minutes from the previous meeting. This will help the group maintain focus.

Team members should be representative of any department that has a part in the revenue cycle process. This encompasses clinical, financial, and information systems. Construct a path that a patient would take from the time he/she thinks about coming to your facility to the point when they receive the final bill for services received. The areas of your facility identified in that "path" become the representative section of your denial management task force. Inpatient and outpatient "paths" will be different, but the team members should be from both area types.

Goal setting is an important first step for your task force. Identify your facility's current denial rate. Set reasonable, attainable, and timely goals. Track your progress daily and report the tracking at the weekly meeting.

The success of the team is more likely if each member takes ownership of the concept and goals of the task force. Draft a simple contract that, when signed, states a commitment to identify and resolve key issues and keep the insurance denial rate low.

This question was answered by Tina Clark, senior consultant for the Tintari Group, Des Plaines, IL.

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