The Ultimate Playbook for Mastering Claims Denials and Winning Appeals
Conclusion When faced with a complex problem, it’s wise to begin with the end goal in mind and define the desired outcomes clearly. In the case of claims denials, the focus should be on preventing as many denials as possible, and for those that do occur, being prepared to win the appeals. The goal is to minimize as much revenue loss as possible from claims denials. It’s crucial to take control of this situation to ensure the long-term sustainability of healthcare organizations to provide optimal patient care. As highlighted, HIM, CDI, and Case Management professionals have the skills needed to outsmart payors’ rogue denial practices and are among the heroes who can help save healthcare.
Here are a few takeaways:
√ Denials ultimately impact patient care. √ Many denials are preventable.
√ Past denials can help inform future success. √ Being proactive can bring about lasting change. √ Remember, you are part of the solution.
√ Creative, out-of-the-box thinking solves problems. √ Silos are the enemy of a healthy revenue cycle.
References https://www.beckershospitalreview.com/finance/293-hospitals-at-immediate-risk-of-closure.html https://deming.org/explore/pdsa/ https://www.health.state.mn.us/communities/practice/resources/phqitoolbox/index.html https://www.smartsheet.com/continuous-quality-improvement-healthcare
© AMN Healthcare 2024
AMNHealthcare.com | 17
Made with FlippingBook. PDF to flipbook with ease