Blog Resources Careers Contact Us Records Request About Us Technology Patients Commercial & Govt Providers Health Plans Life Sciences Denials Prevention You are here: Home / Providers / Denials Prevention Navigating Denials Is a Balancing Act Ciox helps healthcare providers manage complex, current denials and prevent systemic, reoccurring denials in the future. 90% of denials are preventable Traditionally denials are an afterthought. But at Ciox we concurrently leverage data and analyze in real time to prevent denials from happening in the first place. A Clinically Integrated Revenue Cycle is critical Denials management and prevention is one of the main reasons that the clinical and financial sides of the organization must collaborate and partner closer than ever before. A Clinically Integrated Revenue Cycle captures a holistic view of the patient experience, which is required to support value-based care models. Clinical and financial resources, processes and technology are no longer siloed, but instead are integrated. Implementation of denials management technology Engagement of all clinical areas Consistent prevention efforts Effective use of data analytics Getting the Job Done: A toolkit for denial prevention in a new age of COVID-19 Download our Denials eBook Better Together: Building a Clinically Integrated Revenue Cycle Download our white paper Read Our Latest Blog Post Clinical Documentation – In it for the long haul While it is hard to believe that we have been in the midst of COVID-19 for over a year now, from a clinical documentation perspective the reality is that we are just beginning. Health information management (HIM) and revenue cycle professionals alike are embarking on a journey that will have many twists and turns in the future; we all need to be prepared to be in it for the long haul. The foundation that healthcare providers must rely upon is their clinical documentation. The accuracy of the documentation within a patient record is more critical than ever before. This applies to all records in all patient care settings – from physician offices and specialty clinics to acute and long-term care facilities. Some patients that had COVID-19 sadly lost their battle to the virus. Other patients recovered after a few weeks with little to no lingering effects. However, there are also many patients who had COVID-19 and are still dealing with the aftereffects. Their journey continues and many of them are now being referred to as “long-haulers.” COVID-19 long-haulers are a unique group of patients who suffer a diverse range of symptoms. Some suffer serious, chronic conditions while others suffer more common issues that can arise at varying times after recovering from the virus. The one thing they all have in common is their symptoms are tied to COVID-19 – and their clinical documentation must reflect their health and care history accurately. Common Issues Experienced by COVID-19 Long Haulers Memory Loss Concentration issues Brain fog Fatigue Joint/muscle pain Depression/anxiety Blood clots Organ damage Increased heart rate Loss of smell or taste Fever Cough Difficulty breathing Dizziness Chest pain Focus on Clinical Documentation for Accurate Coding and Billing for COVID Long-Haulers Clinical documentation has always served as the foundation of patient care. The documentation within a patient record should present “The True Clinical Picture” of the patient and the care provided. Additionally, the record should also contain key information regarding chronic and underlying conditions that may impact current or future care. For many HIM and revenue cycle professionals, the issues experienced by COVID-19 long-haulers look very familiar. Chronic and underlying conditions are well known to us. However, the addition of COVID-19 to the issues above is still materializing. The healthcare industry continues to gain more data by the day and payers and governmental agencies continue to learn and adjust payment requirements on the fly. These ongoing changes present both a challenge and an opportunity for the revenue cycle. Did you know… According to the Centers for Disease Control and Prevention, the 1918 Influenza Pandemic was similar to COVID-19 in that it occurred in three separate waves that lasted from 1918 through 1919? The first mention of influenza appeared in April 1918 when 18 severe cases and 3 deaths were reported. The second wave between September and November 1918 was highly fatal. The third wave occurred in the winter and spring of 1919 and subsided by summer. Healthcare organizations must acknowledge that the lasting effects of COVID-19 will be with us for some time to come. As a result, the clinical documentation, coding, and billing must be a primary focus for all team members. This is certainly not a time to be “penny wise and pound foolish” as the saying goes. Organizations must focus on the bigger picture now so that they are not further impacted in the future because of deficiencies in documentation and billing practices that exist today. Over the last year, organizations have also dealt with insurmountable regulatory change, including but certainly not limited to: Countless new COVID-19-related CPT and ICD-10 codes with varying effective dates Evolving guidance around beneficiary cost sharing, place of service codes, and telehealth modifiers Insurance waivers with varying effective dates New query forms New COVID-related coding guideline Regardless of the approach, your organization selects to tackle all these changes, it is critical that an approach is determined, and that it is taken to heart across the organization. Consider a Clinically Integrated Revenue Cycle One such approach is developing a Clinical Integrated Revenue Cycle. COVID-19 patients, long-haulers, and our patient population require thorough and complete documentation as well as compliant coding. Billing correctly the first time around will save the organization time and money in the long run. One of the first steps is to unite coders and CDI staff. By integrating these teams, creating a Clinically Integrated Revenue Cycle, and proactively addressing potential denials, organizations will be able to boldly state that they are “in it for the long-haul” for their patients, families, and community. Want to learn more about the True Clinical Picture, denials, and building a Clinically Integrated Revenue Cycle? Read Geoff New’s blogs here and his article in the Journal of AHIMA Read More Blogs Ciox’s Holistic, Multi-Discipline Approach to Denials Prevention and Management One approach or method will not serve as a long-term strategy in today’s healthcare landscape. A multi-faceted approach looking at denials through a different lens while utilizing quality documentation and the True Clinical Picture will pave a solid path. Analyze where and why denials occur and isolate the root cause Conduct operational reviews targeting the top areas Provide ongoing educational support to minimize future denials Build and maintain a partner relationship with client leaders sharing data Increase revenue from denial overturns and prevent future avoidable denials through education Comprehensive Denials Prevention and Management Solutions Our services include retrospective reviews and appeals, clinical and technical denials, clinical validation reviews and appeal letter authoring. Our team also offers ongoing education so your organization can sustain a successful denial prevention and management program. Manage Denials Staffing solutions offer short- and long-term support for: Pre-authorizations/pre-certification Appeal letters and follow up Defense audits Revenue integrity Physician and clinical education Prevent Denials Staffing solutions, plus: Leading and lagging metric management Focused prevention (top payers and denial types) Comparative analytics Prevention strategy Defend Against Denials Staffing and Prevention solutions, plus: Denials reporting Audit defense Denials technology and analytics using real-time data Denials follow up Ciox is ready to partner with your organization to enhance your denial prevention and management program Contact Us eVerify Federal ID #116278 March 27, 2014 Contact Ciox Quick Links Join Our Team Ciox in the Press Client Login Privacy Policy From Our Blog Health Catalyst Partners with Datavant to Expand Access to Clinical Trials as a Care Option for Patients With Privacy Hub, Datavant Strengthens Protections for Patient Privacy in Health Data Exchange No-Cost Quality Improvements: Strategies from Ciox Health Follow Us © Copyright 2021 - Ciox