Achieve Denial Avoidance with Revenue Integrity Consulting

Our Strategy for Hospital Denial Avoidance – ICU Stays

Learn more regarding how Advent Health Partner’s Revenue Integrity Consulting team can leverage Optics reporting, our denial management analytics delivered in drill down dashboards, to help hospitals and health systems implement denial avoidance programs. Keep reading for a specific example of our team utilizing Optics data to help a hospital implement more precise protocols regarding ICU stay documentation – and ultimately decrease related denials.

Our Process for Hospital Denial Avoidance – ICU Stays

  • Step 1 – The Situation

ABC Medical Center is experiencing increasing denial rates without additional staff to review or appeal.

  • Step 2 – The Data

Enter Optics – denial management business intelligence analytics by Advent Health Partners. 90 days after completion of Optics implementation, the drill down view of “Monthly Denials by Payer” indicates a sustained, abnormally high denial percentage of ICU stays from XYZ Health Plan.

  • Step 3 – The Consultation

To prove medical necessity, the Advent Revenue Integrity Consulting team chooses a resident sampling of documentation. The team discovers medical necessity for ICU stays is often only implied due to incomplete protocols or missing documentation.

  • Step 4 – The Process Improvement

Advent Health Partners team meets with physicians and nurses to discuss their protocols, CMS guidelines, and XYZ Health Plan guidelines needed to prove medical necessity for ICU stays. ABC Medical Center updates protocols and incorporates guidelines for appropriate documentation when the patient’s condition supports an ICU stay.

  • Step 5 – The Results

ICU stays are now paid by CMS and XYZ Health Plan at the time of submission – instead of overturning the denial on appeal, effectively increasing ABC’s clean claims rate + decreasing time-to-revenue.