Q&A: Structuring denials management

Q: How is revenue integrity involved in denials management?

Jayne Hildebrand, MBA, CHFP, executive director of revenue integrity, UnityPoint Health, West Des Moines, Iowa: Our team is not necessarily working the denials but is focused on denials analysis and then trying to push those opportunities forward.

Kay Larsen, CHRI, revenue integrity senior charge assurance associate, Adventist Health Glendale, Glendale, California: Revenue integrity does a lot of the groundwork. [Denials] come to us, and [we] will confirm the code. We’ll contact the clinical department for a correction, [or] if everything is correct as-is, then it goes to the denial team.

LeAnn Luczek, CRCP, revenue integrity director, St. Joseph Chandler Health System, Savannah, Georgia: We look at denials as a whole to try to identify the root cause. We look at those trends in work groups and try to prevent them. We have the ongoing daily work, and then we have analytical [projects] that we’re working on as well. Revenue integrity is involved with both.

Editor's note: This Q&A was excerpted from the 2025 State of the Revenue Integrity Industry Report. Interested in more analysis of revenue integrity trends? Check out the recording of our free webinar that aired on June 4!