RAFFED: A unique approach to keeping your denials management team on the right path

Yes, yes...I know that RAFFED is a bit of an odd word. However, I’ve taken some creative liberties in my approach to revenue cycle management, and in motivating staff to increase productivity while being successful in collections.

In one of my past lives, I simultaneously managed denials for 14 facilities. My staff utilized a software program that had work pools designed to separate accounts by “payer.” The productivity standards were 30 accounts per day. However, the staff was not always able to meet their goals and, if they did, efficiencies were often compromised.

We were receiving a whole lot of waste that distracted staff from the real issues -- not real denials. Many of the accounts were “patient responsibility” and only required the balance to be moved from the insurance bucket to the patient bucket. In addition, the system was not updated or correctly implemented with new insurance rates. Inaccurate insurance plan identifiers were being used, creating a false A/R. These accounts inflated the A/R and should/could have been resolved prior to placing with the team. This slowed staff down and kept them away from where they needed to be: working on true denials and required appeals. In addition to erroneous account placement, there was no real process for resolving accounts.

As a result, work pools were consistently bottlenecked. The monthly review of A/R was always in question, but we had to defend it by stating that we had to “get through the muck before getting to the buck.”

I wanted my staff to feel that they were achieving attainable goals -- not to feel the stress of being unable to get to the accounts that needed attention. The above-mentioned “waste” still needed to be addressed, so we had to accept the current process/policies (until standardization became the hot topic...but that’s another blog).

How did the RAFFED acronym come about?
We needed to develop an “account review” process for the staff that made sense, was attainable, and allowed them to be successful. The first step was to develop a pilot with a lead and two staffers. We discussed how they approached their accounts on a daily basis. From those conversations, I was able to create a step-by-step process with specific daily activities and an account resolution map. I instinctively knew that the best way to remember the resolution process was to create an acronym. In this case, it was: R.A.F.F.E.D.

Some denials management teams may find the RAFFED approach, or some of its components, very helpful. It can be modified. The goal is to create something for your staff to follow.

Basic Components of the RAFFED Approach:
Review - On Monday and Wednesdays, the teams review and research accounts. If they discover anything that requires an appeal, those accounts are tickled (or a reminder notice is added, but it all depends on how sophisticated your system is) for the next day. For part of the day, time is dedicated to generating patient letters. As mentioned, some accounts are “patient risk” and require moving to the self-pay bucket.

Appeal - On Tuesdays and Thursdays, the teams write their appeals. They also attend to other duties, such as working with their nurse reviewer for clinical denials and adding information to the payer log, which includes details required for monthly payer meetings.

Follow-Up - once appeals have been sent out, we follow up within 15 days to ensure that the appeal is in process and has a tracking number (sometimes payers do not send that acknowledgment letter). Once the team confirms that an appeal is in process, the account is then tickled for 30 days (resolution typically is 45 days).

Follow-Up - Why are there two follow-ups? As I mentioned, the account is tickled for 30 days and this is a way to ensure that the account has been resolved.

Escalate - If the appeal process is unsuccessful, the staff member is required to escalate to management for resolution.

Determination - At this point, the account is hitting - or past - 120 days (the payer may have a two-appeal process or “meet and confer” clause). A decision is made to either adjust, or outsource to a collection or legal vendor.

Most of the activities above are completed between Monday and Thursday. We like to designate Friday as an open day whenever possible. Fridays are designated for getting caught up and ready for the next week: addressing emails, reviewing credit balances and zero balance accounts.

Why try the RAFFED approach?
Because it works. The pilot for this process was conducted over a 30-day period and resulted in a productivity increase of 32%. The staff was excited and felt as they were getting through their accounts more efficiently. The quality of appeals increased and overdue tickles decreased.

Business office staff queues are never empty. They’re constantly replenished with new accounts that require attention, which, as mentioned, can cause bottlenecks. Once your team reaches the “Determination” part of RAFFED, you should always be looking to outsource, unless of course you identify an error on the facility part. (That doesn’t happen, right?)

It’s very important to have vendors that can focus on addressing resolution, especially when accounts sit in A/R and new accounts are quickly coming through. This unnecessarily inflates the A/R and, in many cases, the cost to review it may be more than the balance of the account.

If you’d like to discuss more on this approach - and how Medicor Group may assist you in reducing your chronic bottleneck - please contact us.

Kareem Aqleh
President
Medicor Group

Kareem Aqleh is president of Medicor Group, a full-service coding, billing and consulting service for hospital outpatient services, including wound care. He is also Vice President of revenue cycle at Wound Care Advantage.

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