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    Beverly Gibson
    Beverly Gibson, MBA, M.Ed., CMPE, CPC, CPC-I, CPMA, CEMA, CIFHA

    If we want to get paid for the work we do, we must submit clean and accurately coded claims and hold payers accountable.

    About 90% of rejected claims are preventable, and more than 70% of denied claims can be overturned. A robust denials management system is vital to making that happen.

    The right system can help to identify where the most money is lost, determine the root causes and focus efforts on developing corrective actions and prevention plans.

    The following checklist outlines ideal features of a denials management system that will provide practices with the level of reports, ease of use and functionality to be worth the investment.

    Denials management system assessment checklist

    Interfaces with PM. Customizable (e.g., categorizing denial codes and assigning root cause of error). User-friendly. Reports are easy to read; data is downloadable and can be manipulated.

    Ideal Features  
    • Interfaces with practice management system
    • Customizable (e.g., categorizing denial codes and assigning root cause of error)
    • User-friendly
    • Reports are easy to read with downloadable data that can be manipulated.
    • Patient name
    • Medical Records Number (MRN)
    • Subscriber number
    • Employer plan number
    • Date of service (DOS)
    • Procedure code(s)
    • Description of procedure codes(s)
    • Fee(s)
    • Diagnosis code(s)
    • Description of diagnosis code(s)
    • Modifier(s)
    • Payer
    • Date of denial / rejection
    • Remittance identification number
    • Denial / Rejection Code(s)
    • Description of Denial / Rejection Code(s)
    Allows the addition of  
    • Category of denial / rejection code: (e.g., coding error, patient registration error, precertification)
    • Assignment of blame: payer or provider (staff member)

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