title: Avoidable Technical and Clinical Denial Write-Off Management in Hospitals, Physician Offices, and Clinics.
abstract: OBJECTIVE
  This article reviews the various types of technical and clinical denials that are usually "written off" and proposes strategies to prevent this loss. For purposes of this writing, avoidable technical and clinical denial write-offs are defined as revenue lost from "first-pass" denials rejections. For example, a procedure that requires an authorization is performed without having had an authorization obtained. After appeals and attempts to recoup the revenue, often unsuccessful, the organization ultimately "writes off" the revenue as not collectable. The question to ask is: Are these claims really not collectable or can actionable steps be taken to conserve these dollars and improve the bottom line?
  
  
  METHODS
  Acute care hospitals, physician offices, and clinics.
  
  
  CONCLUSIONS
  In today's environment, the need to manage costs is ubiquitous. Cost management is on the priority list of all savvy health care executives, even if margins are healthy, revenue is under pressure, and the magnitude of cost reduction needed is greater than what past efforts have achieved. As hospitals and physician clinics prioritize areas for improvement, reduction in lost revenue-especially avoidable lost revenue-should be at the top of the list. Attentively managing claim denial write-offs will significantly reduce lost revenue.
  
  
  CONCLUSIONS
  There is significant interface between case management and the revenue cycle. Developing core competencies for reducing clinical and technical denials should be a critical imperative in overall cost management strategy. Case managers are well placed to prevent these unnecessary losses through accurate status determination and clinical documentation review. These clinical professionals can also provide insight into work flow and other processes inherent in the preauthorization process.
authors: Sandra Marlene Terra, DHS, MS, BSN, is President of The Terra Firm, a Case Management Consulting Group. Dr Terra has led multiple teams responsible for determining cause, responding to and preventing regulatory and commercial clinical and technical claim denial in acute care hospitals in both urban and rural settings. Amanda Byrne, BA, is Managing Consultant with the Healthcare Performance Improvement Practice at BRG. She has a primary focus on Revenue Cycle and physician practice optimization. Her denial management experience includes opportunity assessments and performance enhancement implementations, denial data analytics, reporting, tool enhancements and implementations, workflow, and staffing management.
authors: Sandra Marlene
authors: SM
authors: Terra
authors: Amanda
authors: A
authors: Byrne
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics*; D004469:Economics, Hospital; D004496:Education, Continuing; D007349:Insurance, Health, Reimbursement; D010824:Physicians' Offices / Q000191:economics*