Denials management is not a new concept, but the landscape has shifted dramatically.
The traditional Medicare-centric focus is no longer sufficient as commercial payers and Medicare Advantage plans adopt more aggressive denial tactics. Hospital systems must take a comprehensive, cross-functional approach to denials, incorporating payer contracting, HIM, CDI, and revenue integrity into proactive strategies.
These industry insights address the challenges by proposing innovative best practices for hospitals of all sizes and specialties.