Denials and Appeals

In the 2022 NAHRI Leadership Council survey: Custom Edits—Creation and Workflow, 100 leaders, including revenue integrity, health information management (HIM), and coding directors and managers primarily from acute care hospitals and health systems with 500+ beds shared key insights into their custom edit processes, including workflow locations, oversight hierarchy, and the leading factors that drive custom edits.

Focus on the people and processes that make revenue integrity work.

Apply these tips to reduce and prevent common denials due to medical necessity, the three-day payment window, and more.

Understand how to navigate evolving guidance on observation services and medical necessity.

Diane Weiss, CPC, CPB, CCP, CHRI, looks at trends in payer audit activity.

Jerilyn Morrissey, MD, shares why revenue integrity professionals need to think outside the box to address denials and understand payer performance.

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

Q: How is your chargemaster staffed and managed?

Tina Rosier, MS, PT, discusses how her organization deployed tools built into the EHR and focused education to prevent inpatient only denials in the cardiac catheterization laboratory.