The Ciox denial prevention solution will:
- Provide a unique, holistic, multi-step, multi-discipline approach to denials.
- Analyze the where and why denials occur and isolate the root cause.
- Conduct operational review targeting the top areas.
- Provide ongoing educational support to minimize future denials.
- Build and maintain a partner relationship with client leaders sharing data.
- Increase revenue from denial overturns and prevent future avoidable denials through education.
- Retrospective authorization updates.
- Retrospective clinical medical necessity reviews and appeals (e.g. Medicare, Medicaid, Managed Care, Commercial, Third Party).
- Ongoing education to change operational behaviors currently impacting denials.
- Professional team of multispeciality clinicians, active licensures and accreditations in areas of clinical expertise.
- Thorough understanding of Medical Necessity Criteria throughout the continuum of care as it relates to admission, continued stay, and discharge as well as post-discharge care.
- Excellent authoring skills and the ability to engage in active clinical discussions as needed.
- Dedicated to working appeals exclusively.
- Onsite or remote
Top 5 Best Practices
- Effective Use of Data Analytics
- Implement Denials Management Technology
- Engagement of All Clinical Areas to Prevent Denials
- Consistent Prevention Efforts
- Partner with Ciox
One approach or method will not serve as a long-term strategy in today’s healthcare landscape. A multi-faceted approach looking at denials through a different lens while utilizing quality documentation and the True Clinical Picture will pave a solid path.