Blog /

From Crisis to Best Practice – Using the COVID-19 Pandemic to Create a Better Denials Program

Publish Date
Read Time
May 18, 2020

The farthest thing from the minds of HIM professionals during the COVID-19 pandemic is the aftermath that will be experienced in the days, weeks, months, and perhaps years ahead. Today, HIM professionals are doing what they do best – bringing order to chaos by following the example set by the “First Lady of HIM.”[1]

During World War I, Grace Whiting Myers, the founder of what is today the American Health Information Management Association (AHIMA), supplied the American Red Cross with weekly information outlining the medical and surgical aspects of the war. Today, HIM professionals are following in her footsteps, bringing order to chaos by ensuring that those serving on the front lines of the COVID-19 pandemic have the patient information and data necessary to provide patient care while continuing to protect and preserve patient information that will be crucial in the future.

As COVID-19 began to spread, healthcare organizations focused on being prepared to care for patients and HIM leaders were right there to ensure that medical information was properly captured and reported. That meant keeping up with evolving guidelines for documenting and coding COVID-19, on top of staying abreast of health insurance provider coverage of testing, prevention, and treatment of COVID-19.

It has now been a couple of months since COVID-19 was declared a pandemic and healthcare providers have submitted thousands of claims for reimbursement and, while everyone is doing their best to submit clean claims, given the ever-changing guidance from throughout the industry, denials are inevitable.

Why not take this crisis and turn it into an opportunity to create a better way to manage denials and the revenue cycle, a way that brings together clinical and financial pathways rather than maintaining the traditional siloed approach? Now is a good time to consider building a Clinically Integrated Revenue Cycle (CIRC).

Webinar: How a Clinically Integrated Revenue Cycle Addresses Denials Challenges
Access recording

I recently wrote an article that was featured in Journal of AHIMA online about the changing landscape of the revenue cycle and how a CIRC takes a holistic view of the patient experience that integrates and involves both clinical and financial teams. Read the full article.

HIM professionals have always operated in the middle, between clinical and financial, and are experts in the requirements, rules, and regulations for complete and accurate billing. The transition to a CIRC is a complex undertaking, but who better than HIM professionals to serve as transformational leaders? We have the knowledge, skillsets, and understanding of the connectors required to support a CIRC. So, are you ready to lead the way to a CIRC in your organization?

[1] Legacy of the ‘First Lady of HIM’ Lives on through Grace Award: AHIMA Founder Grace Whiting Myers’s Work Set Stage for Award Winners to Thrive in HIM

Achieve your boldest ambitions

Explore how Datavant can be your health data logistics partner.

Contact us