Hospital Claim Denial Prevention

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According to the HFMA, effective denial prevention could yield up to $5 million in additional revenue for a typical hospital. With ninety percent of denials preventable and two-thirds appealable, a strong denial prevention program can help your organization recover more of that additional revenue faster. This eBook utilizes Advent Health Partners’ denial management and prevention experience to dissect the six most common denial root causes, preventative options, and the benefits of addressing them.

Being accountable for payments by asking questions and understanding the methods for which you’re paid (or not)—adds value to your facility, its patients, and the financial health of both.

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Advent Health Partners helps health systems and hospitals handle their denials. In the decade since our founding, we’ve sifted through hundreds of thousands of claims. Using a multi-faceted approach, customized to the unique needs of each hospital or care provider, we’ve helped many organizations reduce denials and recover revenue they would have otherwise lost.

This eBook utilizes our denial management and prevention experience to help your organization resolve the six most common denial root causes. By discussing preventative steps and a holistic view of the benefits that come with addressing them, we hope your organization can identify areas of potential process improvement and solutions to develop a prevention-first mindset. Topics include:

  • Addressing Common and Unique Registration and Eligibility Issues
  • Preventing and Resolving Authorization Issues
  • Accountability in Missing or Invalid Claim Data Situations
  • The Specifics of Services-Not-Covered Issues
  • Addressing Medical Coding Issues Based on the Unique Needs of a Provider
  • Documentation, Medical Necessity, and Level-of-Care Denials

About Advent Health Partners

Advent Health Partners was founded as an outsourced review vendor in 2010 in Nashville, Tennessee. As our business grew, the Advent healthcare claims review solutions team of registered nurses, credentialed coders, and business analysts spent most of their time sifting through medical record documentation, trying to find decision data–instead of making decisions. Our team then began to build solutions that increase review efficiencies and pinpoint process improvement opportunities for health systems and hospitals.