By Sondra Bruderer, published in ADVANCE Perspective: HIM
If you were to walk into almost any healthcare organization’s business office, you would probably find that staff and Accounts Receivables (A/R) follow the traditional payer-centric model. There is typically the “Government Team” (Medicare, Medicaid and Tricare), the “Commercial Team” (Blues, UHC and Aetna), the “Self Pay Team,” and other supporting players that do not discriminate by payer (i.e., Payment Posting). Individuals within these payer-centric teams are often broken into smaller groupings by specific payer. Some organizations divide work by department or specialty to align the staff with key areas within the organization. One could debate for hours the pros and cons of dividing the work in this way or that. Over the years, your business office has probably tried multiple ways to slice-and-dice the A/R.
Seven years ago, I was introduced to a slightly different concept for denial management. The concept centered on organizing workflow by denials rather than by payer. Staff could still sort work by payer, but the central concept for building work lists was to focus on the categorization of the denials. Therefore, all coding related denials were grouped together, front-end issues grouped, and so on.