I believe that avoiding denials in the first place is the way to utilize our revenue cycle resources, especially our human resources. The more times we have to touch or rework a claim, the lower the value our final reimbursement becomes. Our goal is to get it right the first time. This can best be accomplished by education with our clinical staff in a way that they can relate and understand the general coding and billing concepts.
This document provides guidance on key performance indicators for denials management and revenue integrity, including calculations for denials rates and denials overturn ratios.