Ms. Brandon shared the following tip with Becker’s Hospital Review.
“Historically, clinicians have been involved primarily in the inpatient mid-cycle arena to support the resolution of payer denials. With more robust technology being used to manage the revenue cycle and the increasing numbers of payer onsite nursing staff, expanding the involvement of hospital clinical staff is crucial to securing agreement on approved days and level of care. Engaging clinical staff during the pre-authorization process decreases risk of rework related to incorrect or insufficient documentation in support of authorization. Ensuring that care management is communicating daily with the onsite payer nurse to confirm approval of services reduces the risk of underpayment or late denial notification. Matching the hospital’s internal skill set with those of the payer-reviewers allows critical sharing of clinical information and real-time resolution. This investment of skilled clinical resources improves the efficiency of revenue cycle processes and reduces the risk of write-offs.”
Read more revenue cycle tips here.
If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the “RCM tip of the day” series.
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