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Take the Time to Understand Your Role in the Denials Management Process
Denials are an ever-present challenge that most hospitals struggle with on a daily basis. However, knowing what causes the denials and which departments are responsible is an important part of solving the problem.
Experts say a successful denials management strategy is one in which each department plays a role in the solution. Do you know what your role is? Use the following chart to help establish your road map for success.
Root Cause Area |
Denial Code Description |
Billing |
Additional information required
Charges/claim were split
Filing deadline has passed
Incorrect bill form
Incorrect billing
Missing/invalid attachment |
Case management |
Not medically necessary |
Credentialing |
Denial codes—credentialing |
HIM |
Incorrect level of care
Medical records required
Missing/invalid ICD-9-CM code
Service not documented |
HIM/CDM |
CPT/HCPCS code missing or invalid |
Registration |
Benefits exhausted
COB/primary carrier coverage
Coverage not in effect on date of service
Invalid services
Not a covered benefit
Not a covered dependent
Patient unidentified/need ID
Unauthorized hospital visit
Workers’ compensation liable |
— Source: Christine Armstrong, principal with Deloitte & Touche
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