Fall 2024 Issue

Editor’s Note: Don’t Be Denied
By Kate Jackson
For The Record
Vol. 36 No. 4 P. 4

Denial management has become one of the most urgent—and onerous—tasks in HIM today. And the consequences of doing it poorly can be dire. Each time a payer rejects a request for payment, revenue is lost or delayed, and when the denials pile up, which happens increasingly frequently, cash flow takes a hit. If the hits are fast and furious, the provider’s ability to operate efficiently is hampered.

Denials may occur for a variety of reasons, from preauthorization issues to duplicate claims. A payer may reject claims because it claims the services provided aren’t covered, the patient may not be eligible, or the care was given by an out-of-network provider, but often the problems arise from documentation issues—duplicate claims, claims with errors or lacking essential information, or, often, coding errors.

Managing denials is more than addressing rejected claims; it’s also a matter of preventing future denials. In this issue, contributor John Bohnsack, chief strategy officer for Aspirion—a technology-leading revenue cycle company that addresses hospital denials, underpayments, and complex claims—explores the challenges and looks at the ways that artificial intelligence can help. “By integrating AI,” he writes, “RCM staff can overcome obstacles that trigger denials while boosting efficiency, which benefits providers.”

Because revenue cycle management is so top of mind to industry insiders, it’s the topic of a feature by contributor Selena Chavis. “Razor-thin margins have upped the ante on how health care executives prioritize the effectiveness and quality of revenue cycle processes,” she notes. In “Rev Cycling to a Better Bottom Line,” she looks to experts for their strategies for financial resiliency.

In another feature in this issue, Rebecca Montz looks at how personalized screening for breast cancer is being optimized by advanced breast density evaluation and risk assessment.

In “Leadership Rules,” frequent contributor Susan Chapman gathers perspectives from HIM leaders on the top leadership skills and strategies they consider essential in today’s health care landscape.

Other topics in this issue include an analysis of the state of paper in health care, a look at how clinical decision support is evolving under patient-centered care, and recommendations for standardizing social determinants capture.

Finally, because it’s fast becoming a topic that will surface in every issue, artificial intelligence makes an appearance, as Susan Chapman looks at the role of automation in enhancing patient privacy teams.

— Kate Jackson

kjackson@gvpub.com