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You are here > Home > Reading Lists > Finance & Accounting > Denial Management: Key Tools and Strategies for Prevention and Recovery

Denial Management: Key Tools and Strategies for Prevention and Recovery
Pam Waymack, MBA, CHFP, CPHIT, Rose T. Dunn, FHFMA, RHIA, CPA, CHPS, FACHE, Barbara Aubry, RN, CCM, CPC, CHCQM, Dr. Joseph Zebrowitz

Softbound Book + bonus CD-ROM
Size: 8.5" x 11" + CD-ROM
ISBN 1578397111
9781578397112
HCPro / Opus
November 2005
Price: $149.00

 

Effective denial management demands a committed team approach. Denial Management: Key Tools and Strategies for Prevention and Recovery, a book and CD-ROM package, will show you how to take a proactive approach to denial management.

Denials are not unique to your organization. Denials are an epidemic in healthcare, and the need to rein in the cost and effect denials have on your organization and develop better management practices is critical to your financial success. Stop struggling and start building an air-tight management process. Author Pam Waymack, MBA, CHFP, CPHIT, with the help of three additional experts, presents a systematic, step-by-step approach to managing denials. They show you how to:

  • look at mistakes and understand how and why your organization made them
  • find the source of denials and measure their impact
  • implement successful changes to decrease future denials
  • analyze your success on a higher level that strengthens your processes

The result?

  • Improved cash flow.
  • Increased net revenue.
  • Fewer compliance concerns.

You don't need to be told that the longer you sit on a denial, the more money you lose. What you do need is a strategy for dealing with denials more quickly, effectively, and efficiently. To develop that strategy, you need to understand how and why denials happen. You need to find the weaknesses in your system, fine-tune processes - or overhaul them if necessary - and make sure every member of your staff understands and plays their important role in your organization's financial success. That means taking proactive measures. This resource kit will give you tools:

  • case studies from leading organizations on innovative denial approaches with quantified results
  • step-by-step strategies to help you improve the data available to your organization to prevent future denials as well as keys to manage the recovery process
  • a wealth of easy-to-use denial tools you can customize for your organization, including denial definition checklist, remittance advice self-audit spreadsheet, and contract language suggestions

Who should have access to this book and CD-ROM? It is not just for the finance team charged with maintaining the bottom line, but for the executive team and other members of the revenue cycle team. Everyone will learn and understand what they need to do to erase bad habits, reassess the organization's progress, and develop a process that addresses the ongoing denial management challenge. This kit is an important daily resource for everyone who needs to learn valuable strategies to help their teams make stronger contributions to the organization's revenue cycle:

  • provider-based managers of the revenue cycle, including the finance staff, PFS directors, and managed care directors.
  • members of the all departments impacting denials, including:
    • executive suite,
    • patient access,
    • HIM,
    • case management
    • utilization review,
    • compliance
    • audit departments

This book and CD-ROM resource provides discussions, tools and strategies while covering fully the following topics:

  • Why worry about denials?
  • Measuring your denials
  • Focusing operational efforts to reduce denials
  • Clinical denial management: Where finance and medicine collide
  • Using technology in managing denials
  • Managing the revenue recovery process
  • Legal avenues for recovery
  • Case studies

Pam Waymack, MBA, CHFP, CPHIT, is managing director of Phoenix Services Managed Care Consulting, Ltd. in Evanston, IL, a firm that specializes in improving financial performance in healthcare. She has 25 years of experience in managing and turning around the financial performance of healthcare organizations across the country.

Rose T. Dunn, FHFMA, RHIA, CPA, CHPS, FACHE, is chief operating officer of First Class Solutions, Inc. of St. Louis, Mo. During her 25 year career Rose Dunn has had more than 200 articles published, is a sought after public speaker on a variety of healthcare subjects, and has authored books on legal aspects, finance, and management. She has served as a faculty member at the University of Minnesota's Healthcare Administration Program, teaching finance; at St. Louis University's School of Business, teaching management; and at Stephens College's Health Information Management Program, teaching legal and ethical aspects, management, and finance.

Barbara Aubry, RN, CCM, CPC, CHCQM, is a healthcare policy specialist for 3M HIS in Rockleigh, NJ. She is a contributor to HCPro's PFS Advisor, PFS Weekly Advisor, and to Compliance Monitor's "Ask the Expert" column. Dr. Joseph Zebrowitz is executive vice president of Executive Health Resources (EHR) of Newtown Square, PA. In this role, he has developed EHR's suite of clinical revenue cycle management services - endorsed by the AHA as "Best in Class."

Softbound Book + bonus CD-ROM
Size: 8.5" x 11" + CD-ROM
ISBN 1578397111
HCPro / Opus
November 2005
Price: $149.00

 

Effective denial management demands a committed team approach. Denial Management: Key Tools and Strategies for Prevention and Recovery, a book and CD-ROM package, will show you how to take a proactive approach to denial management.

With more than 17 years of experience, HCPro, Inc. is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. The company's mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry. As an acknowledged industry authority in healthcare regulation and compliance, HCPro focuses on providing its expertise in the areas of accreditation, medical staff affairs, credentialing, privileging, medical record management, regulatory compliance, nursing, quality/patient safety, infection control, and workplace safety.

Please remember that the government no longer allows a grace period for annual code sets. The new HIPAA Transaction and Code Set Rule requires providers to use national medical code sets that are valid at the time that a service is provided. ICD-9-CM code revisions become effective October 1st each year while CPT and HCPCS code revisions become effective January 1st. In order for you to meet this requirement, you must have the revised CPT, HCPCS, and ICD-9-CM codes in your possession before the implementation dates. The best way to do this is to order your code books early. Review current coding resources.

(information from the publisher)

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