A winning game plan for overcoming payer denials — Insights from CorroHealth + CommonSpirit

Originally Published on Beckers Hospital Review

During a feature session as part of Becker’s 14th Annual Meeting, Jerilyn Morrissey, MD, chief medical officer with CorroHealth, and Elizabeth Quinn, MD, system senior vice president, internal physician advisor service, with Chicago-based CommonSpirit Health, discussed the challenges of dealing with Medicare Advantage denials and the importance of a strategic approach to the revenue cycle.

They emphasized the need for health systems to understand their own processes and the tactics of payers, and to use data to inform their strategies.

3 takeaways:

1. Rising costs place added pressure on hospitals and health systems. This trend isn’t likely to reverse anytime soon.

   “In any other industry, rising overhead costs serve as justification for increasing prices for costs and services and goods. In healthcare, we can’t do that. Our prices are regulated by the federal government, the state government, and commercial payers. In such an environment, there are things we can control and things we can’t. But there are also things we can influence.” – Dr. Jerilyn Morrissey

2. One way health systems can exert influence over the situation is to take a proactive approach to denials prevention.

   “At CommonSpirit, we’ve dealt with increasing denials and decreasing reimbursements, all while striving to provide the best quality care possible. To influence this, you have to get proactive. You have to defend against payer denials, but you have take an offensive mindset when doing so. The first step: Know your opponent.” – Dr. Elizabeth Quinn

3. Continuous revenue cycle education among both leaders and front-line clinicians is essential for sustaining positive fiscal performance.

   “You have to help everyone understand that this is a team sport and everyone has to play their part to be successful. We have educated and will continue to educate our leaders. When a physician comes to us and says, ‘I just want to care for and advocate for my patients,’ we have to remind them that executing appropriate documentation to prevent denials is also a form of patient advocacy.”  – Dr. Elizabeth Quinn