At Moffitt Cancer Center, a robust denial prevention program resulted in reducing denials from 14% of gross charges to 8% of gross charges billed. The process involves a multidisciplinary team, a data-driven strategy, a preventative approach and a missional, patient-centric perspective that extends across the organization. The first step to their success was the creation of a multidisciplinary steering committee focused on evaluating denials and assessing potential solutions to avoid future denials.
Having an executive sponsor attend committee meetings demonstrates to the team that this initiative is a priority. Because you’ll want your committee to be multidisciplinary, recruiting both the Chief Financial Officer and Clinical Executive such as the Chief Medical Officer is a good way to represent both financial and clinical interests and drive new processes forward across all critical areas of the organization.
Take a Multidisciplinary Approach
A key to a successful denial prevention strategy is a multi-disciplinary approach with leaders representing both the clinical and financial sides of the organization. Opportunities to prevent denials exist throughout many functional areas outside of finance. Coding needs to know, for example, the importance of staying on top of payer policies and ensuring that claims are submitted with appropriate documentation. Your steering committee should include representation from Patient Access, Utilization Review, Health Information Management, the Business Office and clinical areas.
Our steering group has representation from revenue cycle, physicians, radiation oncology, and case management. –Joanna Weiss, VP of Revenue Cycle
Time to Recruit
Recruiting steering committee members might be challenging for some healthcare organizations, but it also might be easier than you anticipate as it was for the Moffitt Cancer Center. Here are some tips:
- Communicate the value of this initiative by stating your goal and the impact it will have both on the organization as a whole and on each individual team.
- Show how the effort ties to your mission and the impact it will have for patients.
At Moffitt, the goal of reducing administrative denials from $4 million to $2 million meant $2 million more to invest back in patient care.
One more dollar recovered represents one more dollar the Center can invest in curing and preventing cancer. That objective automatically garners excitement and engagement. –Joanna Weiss, VP of Revenue Cycle
Set realistic time investment expectations for employees and leadership: Moffitt estimates that for them, thetotal time spent on this project is probably half to three quarters of a full-time employee, or 120-140 hours a month between the report-out, presentations and meetings. VP of Revenue Cycle Joanna Weiss estimates she spends about 2 hours a month on their denials prevention initiative.
Schedule regular meetings, starting with a monthly meeting and then reassessing needs. It’s possible that a monthly meeting won’t be the best use of everyone’s time, at which point you can switch to bimonthly meetings and designate subgroups, which can meet more frequently and focus on initiatives that are specific to their team.
Designate a project manager to oversee all tasks across teams, performing regular check-ins and monitoring progress. At Moffitt, the project manager spent 40% of her time on data trends and root cause analysis related to denials.
When creating a multidisciplinary team focused on denials management you can come across many challenges.
- Getting buy-in
- Recruiting participants given the time commitment
- Scheduling committee meetings that accommodate everyone’s schedules
Want to learn more about creating a denials management program?