Solving denials through documentation improvement
Editor’s note: Elizabeth M. Aguirre, MD, CCDS, and Jared Brock, MBA, will present “Having Real Impact on Denials” on day one of the 2024 Revenue Integrity Symposium, which will take place September 12–13 in Oak Brook, Illinois. Aguirre is the inpatient clinical documentation physician lead at Baylor Scott & White Health in Temple, Texas. Brock is the system director of clinical documentation integrity (CDI) analytics at Baylor Scott & White Health in Temple, Texas. 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 (the application deadline is May 28).
Q: In what ways does your session challenge revenue integrity professionals to think outside the box?
Aguirre and Brock: Revenue integrity professionals track clinical encounters and focus on translating those encounters into revenue. In our experience, the main focus of revenue integrity has not historically been to prevent denials but rather monitor, track trends and appeal denials. Thinking outside of the box, we would challenge revenue integrity to partner with clinical professionals in their organization to provide denial prevention strategies for top clinical denial areas.
Q: What’s the biggest challenge in revenue cycle right now? How does your session help tackle this?
Aguirre and Brock: We do know that denials necessitate a large amount of focus for our partners in revenue cycle. Additionally, as a CDI team, we understand how AI has resulted in an increase in clinical validation denials. As a CDI team, our focus has been working with clinicians to ensure that documentation supports diagnostic criteria and clearly demonstrates treatment to provide the best opportunity of getting denials overturned and translating the clinical encounter into appropriate revenue.
Q: What’s one of the key pieces of information you would like people to take away from your session?
Aguirre and Brock: Denial prevention is a team sport that takes collaboration between revenue cycle, denial appeal writers, CDI, physician champions and HIM.
Q: What are you most excited about for this year’s topic? Or, what are you most excited about for this year’s conference?
Aguirre and Brock: We are excited to hear how revenue cycle in other organizations have partnered with clinical team members to predict and prevent denials.