Hodges Jackie
Med-Data Management, Inc., Mandeville, Louisiana, USA.
Healthc Financ Manage. 2002 Aug;56(8):40-50.
Claims denial management can enhance revenue in times of declining payment and increasing cost pressures. Denials usually arise from process problems leading to inadequate documentation. A denial management team should oversee prospective prevention and claims recovery. Prospective prevention minimizes denials by defining scope of service, tracking causes for denials, and improving related processes. Claims recovery improves chances of recovering denied payment.
在支付减少和成本压力增加的时期，理赔拒付管理可以增加收入。拒付通常源于流程问题，导致文件记录不充分。一个拒付管理团队应该监督前瞻性预防和理赔追回。前瞻性预防通过定义服务范围、跟踪拒付原因和改进相关流程来尽量减少拒付。理赔追回提高了追回被拒付金额的机会。
