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Live Denials Q&A 7/16/24 - payer denial trends creating complexity
Manage episode 429438895 series 3000080
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In this episode, Vanessa Moldovan hosts a Q&A session focused on the challenging issues of denials in revenue cycle management. Vanessa, along with the attendees, discusses the complexities around denial prevention, resolution, and best practices. The session covers specific payer issues, including downcoding by Anthem and Humana, as well as rampant documentation requests from UnitedHealthcare. The discussion also provides strategies for handling denials, escalating issues to provider representatives, utilizing contracts, and ensuring accurate coding practices. Expert insights are shared on balancing the administrative burden, proactively managing claims, and leveraging technology to streamline processes. The conversation aims to empower healthcare providers and billers to tackle denials effectively while advocating for systemic changes in payer operations.
00:00 Introduction and Welcome
03:27 Purpose of the Q&A Session
04:28 Host's Background and Experience
05:25 Community and Participation
07:00 First Question: Handling Downcoding 1
1:44 Discussion on Denial Trends and Strategies
23:02 Challenges with Payers and Denials
31:41 Industry Trends and Payer Practices
35:26 Frustrations with Office Testing and Pre-Authorization
37:22 Tactics for Fighting Unjustified Denials
38:27 Challenges Faced by Small Practices
40:21 Importance of Documentation and Predetermination
42:16 Role of Professional Organizations and Social Media
49:12 Differences in Denials: In-Network vs. Out-of-Network
54:53 Leveraging Contracts and Provider Networks
58:46 Final Thoughts and Recommendations
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