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

Patient Financial Services Weekly Advisor, August 5, 2005

If you decide to make physician participation an integral or more regular part of your denial management program, try these three 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, it should 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, she's still responsible for calling the plan.

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," notes Kentucky consultant Linda Peeno. So it may be difficult to get physicians to volunteer, especially if they already resist attending partnership meetings or taking calls for the emergency department.

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