Finding the Gold in Your Denial Database

Most providers track denials to measure the overall extent of the denial problem in their organization and to establish the success of their appeal efforts. But what more should providers be getting out of their denial database? And how else can they use the denial database to reduce denials and increase the effectiveness of recovery efforts?

Evanston, IL (PRWEB) June 21, 2006 -- Most providers track denials to measure the overall extent of the denial problem in their organization and to establish the success of their appeal efforts. But what more should providers be getting out of their denial database? And how else can they use the denial database to reduce denials and increase the effectiveness of recovery efforts?

The new book authored by Pam Waymack www.PhoenixService.net for hcPro Denial Management: Key Tools and Strategies for Prevention and Recovery (http://www.hcmarketplace.com/prod-3659.html) provides a wealth of ideas on questions to ask and variable to add to unleash the power of the denial database. Variables to track from the basic to advanced level are reviewed. Denial reasons that affect every department in the revenue cycle from contracting through to billing are examined. Tracking success through the denial database is discussed including important attributes such as tracking success not just by organization wide overturn rate but by payer, type of service, reason and collector. Finally uses for the denial database internally within the organization and externally are explored.

A Case example
In examining denials for one hospital, Waymack notes that an HMO consistently denied claims for newborns in their ICU. It was determined that this problem resulted not for medical reasons but because the health plan could not find the original referral which was still on the mother's record. Without a referral to readily match to the HMO's claim staff denied the claim as not authorized. By adding a data element to their denial database for age of patient (in months) the hospital was able to find all denials for all plans for newborns and appeal them as authorized under the mother's record.

Why the need to address denials?
With denials at 14% or greater, effective denial management programs are imperative to assuring healthy bottom lines. The answers to provider's denial problems is lying within their denial database. More details on the book can be found at http://www.hcmarketplace.com/prod-3659.html.

About Phoenix Services

Phoenix Services is a healthcare consulting firm focused on improving performance, operationally, financially and strategically. Pam Waymack, MBA, CHFP, CPHIT, CPEHR, is managing director of Phoenix Services in Evanston Illinois. Pam is a national speaker, author and consultant in the area of reducing denials.

Contact:

Pam Waymack, Managing Director
Phoenix Services
847-864-4451
www.PhoenixService.net

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