Reducing Denials

Medical necessity is foundational for a broader set of process opportunities that can reduce denials and help improve care quality. As such, the care management system must be examined to identify gaps that cause denials. When you’re asked, “How can I better manage denials?,” respond with a focus on these ten steps that identify common gaps that can cause medical necessity denials.

Learn the importance of:

  1. Make a Case for Case Management Leadership
  2. Beef Up Your ED Case Management Program
  3. Ensure Observation Management Works
  4. Take Level-of-Care Management to a Higher Level
  5. Have Consistent Processes and Frequent Reviews
  6. Improve the Clinical Documentation Improvement Program
  7. Make the Physician Advisor a True Member of the Care Management Team
  8. Train Staff on the Use and Role of Decision Support Criteria
  9. Engage the Staff with Data-Driven Insights
  10. Use Specific and Objective Criteria Regardless of What a Payer is Using
reducing-denials-whitepaper
Download the Reducing Denials Whitepaper