Breaking the Denial Management Circle

By: Ray Jorgensen

Categories: Accounts Receivable, Billing, PMG Insights Blog

October 21, 2013

It is a cold Monday morning in the middle of flu season.   There are patients lined up at your check in desk and the waiting room is full.  Half of the staff has called out sick. There are doctors and nurses standing around anxiously waiting to get these patients into a room.

The first patient steps up to your desk.  You go on line to check eligibility.  The patient is not eligible.  You proceed to ask the patient a series of questions to determine if the patient has other insurance.  The people in line are glaring at you.  You remember the patient satisfaction survey that has recently been instituted. There has been some pressure to decrease wait time. You make the decision to move the patients along telling yourself that when the line settles down you will go back and check eligibility. This continues throughout the day.  Before you know it it is 5pm.  You drop your billing at the billing office and head home.

Meanwhile in the Billing office, the Billing Director is reviewing the Accounts Receivable and is baffled with the volume of denials due to eligibility reasons.  The front desk staff has assured her that they are checking eligibility on every patient.

Sound familiar?  Does it sometimes feel like you are running in circles when it comes to denial management?  You read articles, go to seminars, talk to your peers.  You think you have created a great plan.  You are posting all denials, producing reports to identify trends and issues and performing training based on the results.

What are you missing?

As was demonstrated in the example above, your front desk staff has many conflicting priorities.  They are going to react to the one that is loudest in their head.   You need to make sure your priority is being heard.

Here are some suggestions:

  1. Share reporting with your staff.  Post simple reports in various spots where the staff will see them.
  2. Create achievable goals and celebrate successes.
  3. Create incentives.  Perhaps include denial rates in performance evaluations.

Most importantly you need to provide timely and consistent feedback.   Providing training is great but as we all know training has a shelf life.  You need to monitor training efforts to identify the effectiveness of the training.

Periodic audits should be done on a consistent basis in order to provide your staff with feedback.  Ideally these audits would be done on a daily basis.  If staff knows “Big Brother” may be watching they are less likely to cut corners!