Analyzing denials data

Wednesday, April 24, 2024

Editor’s note: Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CDIP, CCS, will present “Having Real Impact on Denials” on day one of the 2024 Revenue Integrity Symposium (RIS), which will take place September 12–13 in Oak Brook, Illinois.  is a CDI education specialist for ACDIS at HCPro. She serves as a full-time instructor for the CDI Boot Camps and as a subject matter expert for ACDIS. Get an exclusive insider’s look at what RIS attendees will learn and experience at the event, discuss highlights from the agenda, and more during our upcoming free webinar! Use NAHRI’s justification letter template as a guide to gain your organization’s support for attending. Consider applying for the NAHRI Scholarship, which awards free registration to RIS.

Q: In what ways does your session challenge revenue integrity professionals to think outside the box?

Wilk: The session challenges revenue integrity professionals to think outside the box by introducing them to process development or improvements and technological innovations. These enable proactive prediction and assistance in claim denials, urging professionals to adopt novel approaches to tackle revenue cycle denials management.

Q: What’s the biggest challenge in revenue integrity right now? How does your session help tackle this?

Wilk: The biggest challenge in revenue integrity lies in keeping pace with constantly evolving regulations and payer policies, necessitating a multifaceted approach. My session will tackle this through discussion of the revenue integrity focus on education and training to ensure staff understand coding guidelines and compliance requirements, alongside conducting audits and leveraging technology for streamlined processes and error reduction. Collaboration among stakeholders, including coders, clinicians, and compliance officers, is crucial for effective communication and problem-solving. Staying informed and adaptable to industry changes remains paramount for navigating challenges and optimizing revenue capture in healthcare settings.

Q: What’s one of the key pieces of information you would like people to take away from your session?

Wilk: One key takeaway from the session is the significance of data analytics in identifying denial patterns and root causes. By emphasizing the power of data-driven insights, the aim is for attendees to recognize the importance of proactive measures and process improvements within their revenue cycle operations.

Q: What are you most excited about for this year’s topic? Or, what are you most excited about for this year’s conference?

Wilk: This year, I am most excited about the opportunity to delve into the latest technological advancements in revenue cycle denials management, particularly AI-driven analytics and machine learning. These innovations hold immense potential for revolutionizing how revenue integrity professionals approach claim denials and improve overall revenue cycle performance.  Additionally, discussions around innovative strategies for navigating evolving regulations and payer policies could offer valuable insights for revenue integrity professionals. Furthermore, the opportunity for networking and collaboration with industry peers to share best practices and lessons learned.

Q: What's a great piece of advice you've received regarding revenue integrity? Or, what advice do you like to give people about revenue integrity?

Wilk: A valuable piece of advice regarding revenue integrity is to prioritize meticulous documentation, timely submissions, and proficient communication with payers. Additionally, focusing on patient-centric approaches, such as tailored financial counseling and refined billing processes, can significantly enhance revenue cycle performance and mitigate denials associated with billing issues.