Health Information Management

Topic: Spotlight your HIM department by joining the denials management team

HIM-HIPAA Insider, July 16, 2007

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If you're not already part of the denial-management team, consider joining. The HIM director and department play an important role in the revenue cycle and in managing denied claims. Consider the following reasons for joining the team and offering your insight:

  • Denials due to coding errors or coding-related activities create double work for HIM, so if you can eliminate these errors the first time that staff code the record, you can direct coders to others duties
  • Denials due to coding errors support the creation of additional education opportunities for HIM staff, but they also emphasize the need for ongoing quality and compliance monitoring
  • Participation emphasizes the expertise of coding professionals and how it affects and enhances revenue, claims processing, and related claims-processing functions, such as chargemaster maintenance
  • The HIM director can demonstrate the knowledge of clinical processes that HIM professionals possess
  • Participation leverages the HIM director's expertise in working with physicians to improve documentation
  • Participation recognizes and uses the HIM director's process-improvement skills to improve denial causes and rates

The denials-management committee captures data that identifies the types, sources, and value of denials. Honing in on those large-dollar or large-volume areas will enable the organization to demonstrate a return on the investment of management time to work the denials, reduce future denials, and improve cashflow. Periodically reporting the committee's findings will emphasize to administration that HIM and its counterparts are collaborating for the overall benefit of the organization--a model that's worth mirroring in a number of areas throughout any organization.

Editor's note: This article was adapted from HCPro's book More With Less, Second Edition. For more information, click here.

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