2017 RCM Project: Reducing Claim Denials

 

The 2017 Revenue Cycle Management (RCM): Reducing Claim Denials Project supports Montana Critical Access Hospitals (CAHs) with revenue cycle management by targeting the reduction of insurance claim denials. The focus is to identify and improve processes where claim denials originate (documentation supporting medical necessity, coding, entering patient information, insurance verification, etc.)

A cohort of CAH representatives will work and learn together to identify their most common sources of denials, determine the process that will be targeted for improvement, understand how the process currently works in order to identify the root causes of the denials, generate evidence-based solutions and develop a plan for continuous improvement.

Project Timeline

 

Revenue Cycle Management Project Objectives:

  • To identify and develop best practices for reducing the number or total cost of denied claims at Montana CAHs; supported with metrics to track future performance.
  • To provide a cohort-based performance improvement format around a targeted financial/operational indicator to develop statewide tools, processes and shared learning to improve CAH financial performance and to positively impact financial/operational outcomes at both the individual facility and statewide level.
  • To increase Performance Improvement Network (PIN) bi-directional engagement through virtual and in-person opportunities
    • Virtual Networking – virtual network meetings, training & report sharing using a variety of lean/ QI tools
    • In-person regional project workshops (locations determined by participating facility locations)
    • Completed project sharing opportunities via the MT PIN website and a statewide PIN webinar.