| | JULY 2024 8UTLOOKHealthcare Tech IN MY OPINIONBy Jerald M Archibeque, Director, Hospital Billing, Presbyterian Healthcare ServicesEngaging clinical areas in denial resolutionHealthcare denials are a significant challenge in the complex landscape of healthcare administration. Denials happen for various reasons, including administrative errors, lack of medical necessity, coding issues, eligibility and coordination of benefits issues, or incomplete documentation. Despite efforts to streamline processes and reduce denials, they persist at organizations nationwide, impacting providers and patients. Understanding the causes, consequences, and strategies for addressing healthcare denials is crucial for improving our patients' experience, as well as the efficiency and effectiveness of care delivery. Proactive identification and resolution of denial trends help identify root causes and prevent future denials. Collaborative efforts between healthcare providers, payers, and regulatory agencies are essential to streamline processes, reduce administrative burdens, and improve the overall efficiency and effectiveness of the healthcare system.At Presbyterian Healthcare Services, a not-for-profit integrated healthcare system in New Mexico that includes nine hospitals, a health plan, and a medical group, we introduced denial information to clinical departments to share how workflow and processes--or lack thereof--can cause lost revenue. In 2016, this denial review started with our infusion department. The focus was on denial write-offs or denials in which the revenue is not collectible. This review created better awareness of how each spoke within the entire revenue cycle, including the clinical staff, contributed to the success of the organization. Over the next few years, we began to look at denial `inflows,' which are accounts that have not yet been lost. This approach led to a review Jerald Archibeque, director of hospital billing at Presbyterian Healthcare Services, has spent 25 years in revenue cycle operations for health systems. Presbyterian's Revenue Cycle team is a seven-time winner of the HFMA MAP award, which recognizes hospitals, health systems, and physician practices that meet industry standard revenue cycle benchmarks.Jerald M Archibeque
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