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Top 3 Trends in Denial Management
Blog Feature
Greg Kay

By: Greg Kay on November 21st, 2017

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Top 3 Trends in Denial Management

During our recent webinar session “Denial Management Essentials: The Metrics and Reporting Tools You Need to increase Revenue” we polled healthcare providers on several topics around denial management.

These questions provide insight as to how well organizations are managing denials today.

How would your healthcare organization answer these questions?

Here’s how the live webinar attendees responded…

1. Which primary root cause of denials are you currently most focused on today at your organization?

  1. Registration/Eligibility – 25%
  2. Missing claim data – 0%
  3. Authorization/Pre-Certification – 29%
  4. Medical Documentation Requested – 9%
  5. Service Not Covered – 4%
  6. Medical Coding/Medical Necessity – 29%
  7. Appropriateness of Care – 4%
  8. Other – 0%
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2. Which type of analysis generally gives your organization the most actionable insight?

  1. By payer – 24%
  2. By denial category – 74%
  3. By charges – 2%
  4. By net revenue – 0%
  5. By physician – 0%
DM Q2.jpg3. What is your organization’s biggest challenge around denial management?
  1. Accountability (denial workflow) – 31%
  2. Reporting – 10%
  3. Prevention – 50%
  4. Analytics – 12%
  5. Artificial Intelligence – 2%
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To learn more about what denial management metrics can do to improve your organization, click here

About Greg Kay

Greg has managed and consulted in healthcare for 28 years. He has been with PMMC for the past 20 years and prior to that was the VP of Sales for PCA (Beverly Enterprises’ pharmacy division). Greg has experience in multisite operations management, managed care negotiation from a healthcare provider’s vantage point, and product development/implementation. Greg is a University of South Carolina finance and marketing graduate. Greg was recognized in 2012 as a Business Leader Top 50 Entrepreneur.