Revenue Denial Management
Our denial management methodology provides a comprehensive, cross-departmental framework designed to keep initial denial rates under 5%. By leveraging robust categorization matrices, targeted root cause analysis, and strategic Payor collaboration through Joint Operating Committees (JOCs), we systematically identify and resolve bottlenecks. This proactive approach ensures continuous feedback loops and optimal revenue protection across the entire claim lifecycle.
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Revenue Denial Management
Key pillars of our denial management service that drive measurable outcomes for hospital partners.
Maintain an initial denial rate target of less than 5% per Payor with stratified action plans based on total dollars.
Sort denials into Clinical, Administrative, and Technical buckets for targeted resolution.
Track specific 'Red Flag' categories such as 2-Midnight Rule violations, post-acute care delays, and 30-day readmissions by Payor.
Conduct weekly meetings with front-end, clinical, and coding departments to develop implementation plans and close feedback loops.
Establish monthly Joint Operating Committees (JOCs) to discuss systemic denial trends and align clinical expectations.
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