Q&A: Tracking denials

Friday, June 10, 2022

Q: What processes do you have in place for tracking and reporting denials data?

Frank Cantrell, CHRI, corporate director of revenue integrity at Penn Highlands Healthcare in DuBois, Pennsylvania: At my facility, we have software called ComplyTrack, which was really more of a RAC-based program, and compliance was in charge of that. All of that transferred over to me and the revenue integrity department. I hired [an employee] to come in and adapt ComplyTrack to also track our general denials, not just necessarily for RACs. What we were able to do is then not only track by all the different reasons but also by payer, and then we also broke that down. Sometimes it’s not necessarily United or Aetna; they’ve hired HMS and EquiClaim. We can even get that granular to find out which third-party entity they have contracted with and what those people are focusing on. We’ve been able to find some common threads amongst payers and amongst those third-party individuals, like HMS and EquiClaim, [and] know where they’re hitting so we can concentrate our efforts on auditing and education with departments.

Priscilla Frost, AGS, CPC, CEMC, CPMA, PCS, PESC, compliance auditor/revenue coordinator at North Caddo Medical Center in Vivian, Louisiana: That was something that when I got here I found they didn’t have a good process. [I came] from a larger facility where [payers] love to audit and deny things, so we are working on developing that to get a good feedback process of what’s being denied. [We’re also] looking to see whether the denials are because of coding, whether it be diagnosis coding or payers just not liking what we sent them.

Shawishi T. Haynes, EdD, FACHE, director of revenue cycle, managed care, and revenue cycle integrity at Valley Presbyterian Hospital in Van Nuys, California: We do track denials by payer but really just our high-volume payers because we are on an older version of Meditech, so all of the tracking is manual. We also track by the type of denial based on the CARC code that comes from the 835. We have a data dump and then we analyze the data in Excel using pivot tables.

Paula Twiss, MBA, CRCS-P, CRCS-I, supervisor of revenue integrity at Monument Health in Rapid City, South Dakota: I use a combination of different tools for tracking denials. I have a dashboard that people can see across the system. I also have created two of my own personal dashboards. Our EHR is Epic, so I’m able to go in and look at specific things and target specific areas and any project that I am working on. An example would be we have a National Drug Code issue that we’ve been working on for a while. On my personal dashboard I have a project dashboard where I’m monitoring that specific denial to see if there’s lots of them coming in, if we’re maintaining, if we’re getting them worked. Also, for professional billing as well, focusing on a dashboard with their denials. This year I’ve been focusing on our aging denials and trying to get those cleaned up. I trend that and monitor [whether we’re] getting to those older denials. If not, then I’m, as a denial management facilitator and revenue integrity, I reach out to the partners and see if we can make some initiatives to get those done. I also use reports out of our EHR and create pivot tables and initiatives on what’s trending, what’s our top denial, what’s our top denial reason, how do I need to get involved to reduce those. A lot of work has gone into our denial management program at Monument Health, and we are starting to see with our metrics the work that has gone into that.