Denial Management Trends for 2021
Denial Management Trends for 2021 While medical necessity remained the number one type of denials in 2021, our team has seen three additional denial management trends emerge as significant sources of denials. If your hospital or health system is experiencing any of these denials, know that there are answers and ways to prevent them from […]
5 Strategies to Help Interpret Denial Data
Data and data analysis are an integral part of denial prevention and 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 […]
Clinical Expertise Overview [VIDEO]
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
3 Considerations for Denial Avoidance 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 […]
5 Tips for Healthcare Providers to Better Prevent DRG Downgrades
Why learn to prevent DRG downgrades? The clinical downgrading of diagnosis-related groups (DRG), or DRG downgrades, has become an extremely problematic issue for healthcare providers over the past decade. Overall, denials related to DRGs are increasing; downgrading target DRGs without even requesting documentation can also happen. One healthcare system, for example, found that DRG downgrades […]
Outpatient Appeal Management at Northeast Health System
The Challenges An extensive Northeast health system, consisting of 30+ hospitals and more than 7,000 beds, found it challenging to manage their outpatient appeal managements. While the business operations were largely centralized, the limited clinical resources tasked with defending denied claims were navigating multiple EMRs and systems, as well as having to write persuasive appeals […]