This challenge is addressed at a monthly revenue cycle operations meeting, the system’s COO/CFO Mark Thompson told Becker’s. In attendance with him are leaders from across ThedaCare, including the chief clinical officer, chief legal officer, chief medical officer and managed care leader. The system’s CEO is also regularly in attendance.
“We actually go through this whole process as a collective group because at points in time, we’re getting denied, in my view, not for clinical reasons. Sometimes we’re getting denied because that’s what the contract said. So then I’ll [get] the managed care person and CMO and say, ‘Let’s get [the payer] on the phone and have the real conversation.'”
Mr. Thompson added that each denial affects the patient and the team is working to ensure that their efforts are focused on providing the best care for patients, which includes only rendering necessary services.
Mr. Thompson said that legal team members were not originally part of the group, and they’ve been brought into the fold in recent years. He said that no lawsuits have been filed, but they have issued a couple letters.
“If you go back four or five years ago, the relationship was not as intense, but something is causing some of these claims denials to surface occasionally,” he said. “We’re going to have that conversation with that payer and get to what’s fair and to what’s right, not only for ourselves, but what’s also right for the patient.”
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