Creating and Implementing a Revenue Cycle Management Denials Committee

A denials committee is a necessity for effective revenue cycle management for hospital and physician groups. It is a great initiative to help organizations identify trends and issues surrounding specific denials, whether they are front or back-end denials. It provides transparency and opportunities for improvements, such as reduction in denials, increased cash flow and reeducation opportunities. With the right tools and participation, this can be a very successful endeavor. There are many crucial aspects and key players necessary in order to be effective. In addition, having the necessary reporting tools and analysis to provide the data are also essential components.

Recently, a hospital with multi-specialty departments in Arizona was seeking to implement a denials committee. Once key players were determined, we had to work with the leadership in the central business office to engage the key players or their designees. Initial communication was sent to executive leadership to explain the intent of this committee and what we were trying to help them accomplish with these bi-monthly meetings. The initial meetings were informational and the meetings that followed were considered working meetings in smaller sub-groups. With multi-specialty hospitals the start-up process can be a little more difficult, but not impossible. It is essential that there is a leader from the organization that is able to identify the leadership for each department.

At the first meeting, we gave an introduction as to who we were, our goals and the end result that we were trying to attain. The initial meeting sparked interest and created a sense of eagerness to find out where the denials were coming from and why. Once there is interest and buy-in from the senior leadership, then the meetings can move forward and be effective.

After the initial meetings, training was provided on the reporting tool that was being utilized as a data tool for denials. The training was broken down into separate sessions to ensure that the users had hands-on experience with the reporting tool. It is important for users to look at reports independently and prepare for upcoming meetings. After the training, we demonstrated the denial trending and provided assistance with report review.

Once the working meetings started, specific examples of the top five denials for the client were provided, including eligibility denials and the front-end staff. Detailed audits on hundreds of accounts were performed in order to provide the details on why the denials occurred and to discuss solutions to reduce these denials. We continued to do audits on the top denials to try and reduce the denial percentage for the client, while asking team members to also investigate on their end.

This is a prime example of how to successfully establish a denials committee. Organizations should consider implementing these committees since it is proven to be effective in reducing denials and increasing cash flow. It is important for health systems to also remember to continue the meetings so that no momentum is lost and their revenue cycle can flourish.

 

 

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