Wellington, FL — (SBWIRE) — 11/20/2012 — HSMN’s recent work with its many clients of all sizes, announces an important and dynamic finding: Denial Management for the Finance community is the closest analogy to disease management in the clinical community. What they have in common are the host organism, many variables, the need for ongoing management and surveillance of symptoms, and honest recognition of the problem.
For over 26 years in its work with various hospitals, physician practice management and many of the country’s most prestigious academic medical centers, HSMN has learned that claim denials are a symptom of problematic systems, people, organizational structure and mission obfuscation. The well trained ophthalmologists can look into the eye and see not only the diseases of the Eye but also the effects of diabetes, hypertension and many other diseases that inhabit the patient being examined. This is analogous to the HSMN focus model in healthcare business.
Denial management must first be understood from a diagnostic perspective. “What are the underlying causes and the variables outside of the payer driven anomalies that are driving the denials?” says Chief Operating Officer, Theo Tarantini, in describing the types of questions that should be posed to begin a thorough analysis. The essence of management is to know just what has to be managed; until all of the causes are found in the revenue cycle stream that contribute to denials, there can be no denial management.
An important factor is that denials have a multiple effect on cost. Fixing denials expends about 1.5 times the worth of the original claim. Organizations may not recognize this fact and end up using the same processes to fix the denials but not the causes, often to their detriment. As part of its healthcare financial management division, the Denial Management Group (DMG) does a complete analysis by type of denial, examines all of the variables and works with hospital staff to gain both anecdotal and empirical information about the existing workflows. Denials strike major fear in the hearts of the financial managers; managers know that the actual value is understated and that they tend to be a revolving door through which the same denials pass.
Financial managers must become like the clinicians and own up to problems, just like disease entities, and begin to come to grips with uncovering the causes. It is HSMN’s experience that bringing in its DMG helps to give managers the tools to perform a root cause analysis of the denials, and then fix them. The DMG’s initial assessment creates tools and processes that are ongoing and used by the staff. HSMN does not believe in the black box theory of consulting; the HSMN firm adheres to the principle that the client should always be given the tools. In most cases this means helping staff to learn how to think critically and not accept the same old excuses from staff for the denials.
HSMN works to categorize denials and match them to the flaws that are found in the processes, systems, people and organizations. Using an algorithm developed over many years of comprehensive denial management and root cause analysis. The causes of the denials are identified, and then those parts of the Revenue Cycle are addressed with a management plan to fix the causes no matter what the variable.
We invite you to contact the Denials Management Group at Health Systems Management Network, Inc. for a brief consultation on our methodology. You can find us on the web at www.hsmn.com or call us now at 866-908-4226.
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