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Articles Tagged With: denials

  • Standardized Process for SNF Transitions Helps Prevent Readmissions

    Using Lean methodology, Monument Health in Rapid City, SD, created a care transition process that reduces excess hospital days, prevents readmissions, and shortens the time it takes from discharge order to the patient leaving the hospital.

  • How to Fight Denials

    Case managers do not have to settle for denials. In fact, they can use their skills to overturn denials. There are certain tactics that can help in this process, and some case management professionals even specialize in this.

  • Best Practices for Maternity Case Management

    In many ways, case management in the maternity and labor/delivery units is unlike other areas of the hospital. Often, the mothers and babies are healthy, and simply in need of support through the process. For that reason, it may even seem that case management is unnecessary. However, it is important to maintain a strong case management department that serves in labor and delivery as well as the postpartum units.

  • Build a Healthy Relationship with Insurance Providers

    It can be a tense relationship. Healthcare systems and providers — including case managers — have admitted it sometimes feels like insurance is the enemy, and patients have been known to carry that same sentiment. How should case managers and other healthcare professionals work out a healthy connection with insurance companies, and even work to strengthen that connection to help build a more positive view of the relationship among healthcare, insurance, and the patient?

  • Thinking Like a Payer


    Part of what makes so many case managers successful is their ability to understand countless roles within healthcare and move between them smoothly. Whether managing discharges, providing social work support, or completing utilization review, the case management experience often is varied. However, many struggle in the quest to work more seamlessly with payers.

  • Analysis Reveals More About Claims Denials Tied to ACA Marketplace Plans

    Meanwhile, evidence mounts indicating access to proper insurance coverage leads to better cancer outcomes.

  • Ways to Build and Improve a Case Management Department

    At some point, a hospital needs to build or improve a case management department. Whether working from the ground up, completely overhauling a program, or simply making slight adjustments, good leadership and strategy is key to a thriving case management program.
  • Case Management at the Entry Points: Ensuring Reimbursement Through Appropriate Surveillance

    At a time when capacity and reimbursement are more important than ever, case managers play a key role in helping operations run smoothly. One way this happens is through monitoring the entry points of the hospital. These points include the emergency department, post-anesthesia care unit, direct admission to the units, or transfers from other facilities. This is not to say case managers should now add “security guard” to their extensive list of roles and tasks; rather, they are uniquely positioned to survey the whole picture, including how entry points are used.
  • Best Practices for Managing Denials

    When denials occur, case managers should create a plan to investigate and manage each one to determine why the claim was denied and how they can help. Using this approach, some managers have uncovered trends and root causes that can prevent future denials. It is critical for case managers to hone this skill for the benefit of the patient and the hospital.
  • Denial Prevention Tactics Are Front End-Focused

    Revenue cycle departments spend lots of time and money appealing denied claims. However, some hospitals are diverting resources to the front end instead.