Theresa Brandon, Managing Director, Novia Strategies: Use denial data to monitor trends by payer. Keep a ticker for each payer, but be mindful of the 80/20 rule. Your contracts will never be able to address all issues that arise, so focus efforts on repetitive and large dollar items. Discuss challenges with your contract staff well before time for negotiations begin. Don’t forget to include your case management and utilization review team members in review of contract language. Their day-to-day insight on patient care may prevent costly mistakes resulting from ineffective or impractical restrictions on delivery of care.
If you would like to share your RCM best practices, please email Carrie Pallardy at cpallardy@beckershealthcare.com to be featured in the “RCM tip of the day” series.
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