Trends in Denial Management for 2021

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While medical necessity remained the number one type of denials in 2021, our team has seen three additional causes emerge as significant sources of denials this year. If your hospital or health system is experiencing any of these denials, know that there are answers and ways to prevent them from occurring in the future. 1. […]

5 Strategies to Help Interpret Denial Data

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Data and data analysis are an integral part of denial management. In some cases, denial management teams need help identifying the important information or the trends they should be looking for. The five strategies below can help teams interpret denial data and best utilize it within the denial appeal process. 1. Analyze your trends for […]

[VIDEO] Clinical Expertise Overview

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A Strategic Partner With Clinical Expertise At Advent Health Partners, we consider ourselves a strategic partner that works as an extension of your team to provide client-specific appeal expertise, real-time reporting, and knowledgeable recommendations. What makes us unique is the diverse clinical expertise that makes us successful as subject matter experts: 95% of our nurses […]

3 Considerations for Denial Avoidance

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Imagine a scenario where a patient needs a necessary surgery like a prostatectomy due to prostate cancer. When the provider and patient decide to move forward with the surgery, it’s essential to set a precedent by talking to both the patient and the insurance company to find out what the out-of-pocket costs will be. By […]

Improving Denial Appeal Rates & Implementing Pre-Bill Reviews

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/ Pre-Bill Reviews / Denial Management /   METROPOLITAN HOSPITAL  600+ BEDS When the newly hired operations executive arrived at the 600+ bed acute care hospital in the Northeast, she immediately identified her first challenge: a facility denial rate almost triple the national average. Plus, her initial assessment determined that this metropolitan hospital lacked the […]

Outpatient Denial Management at Northeast Health System

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/ OUTPATIENT / DENIAL MANAGEMENT /  This extensive Northeast health system, consisting of 30+ hospitals with more than 7,000 beds, found it challenging to work all of their outpatient claims appeals. THEN While the business operations were largely centralized, the limited clinical resources tasked with defending denied claims were navigating multiple EMRs and systems, as […]