Lean 6 sigma principles8/18/2023 ![]() ![]() In order for physician advisors to impact change at a hospital-wide level, it first takes understanding the landscape and terms at play. Understanding Revenue Cycle Management and Denials But first, let’s review revenue cycle management and denials types and causes. I’ve found that the key to successful and sustainable improvements is using a disciplined approach, which I will share with you in this article. ![]() Over the past 10 years, as a performance improvement consultant and physician advisor, I’ve used Lean Six Sigma principles to help hospitals and physician practices improve patient revenue, clinical quality, cost and operational efficiency. The latter requires understanding of the revenue cycle management and performance improvement principles. They already decrease denials on a case-by-case level through concurrent reviews, peer-to-peer discussions and written appeals, and can play a significant role in hospital-wide denial prevention efforts. Physician advisors are uniquely positioned to help hospitals reduce denials. According to one study, out of $3 trillion in total claims submitted by healthcare organizations, an estimated 9% of charges ($262 billion), were initially denied.1 The good news is that 90% of all denials are preventable, and two-thirds of those preventable denials can be successfully appealed.2 Unfortunately, the reality is far from ideal, where payment denials and delays are a common occurrence. In an ideal world, providers would receive accurate, complete and timely reimbursement for their services. Under a fee-for-service payment model, healthcare providers receive payments from public payers (such as Medicare and Medicaid) and commercial payers for patient services such as physician visits, hospital stays, procedures and tests. Read my article, originally published in the January Newsletter of the American College of Physician Advisors, to understand the denial types and causes, and to learn about a disciplined, data-driven and team-based approach to reduce denials. Healthcare providers continue to face financial pressures, which are further exacerbated by payment denials and delays. ![]()
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