Organizations with a strong denial management program are often more successful in recovering denied claims. A denial management program includes which of the following key components?

A strong denial management program is critical for healthcare organizations because it helps ensure that claims are processed effectively and efficiently, which is paramount for revenue cycle management. One of the key components of such a program is performing process improvement and education around specific denial reasons.

This component focuses on identifying trends and patterns in denial reasons, allowing organizations to understand why claims are rejected. By educating staff on these specific issues, they can implement targeted strategies for improvement, such as refining billing processes, enhancing documentation practices, or addressing communication challenges with payers. This proactive approach ensures that the same issues do not reoccur, ultimately increasing the success rate in recovering denied claims and optimizing overall revenue cycle performance.

The other choices do not align with the core objectives of a robust denial management program. For instance, reducing staff workload by minimizing audits could compromise the quality of checks and balances that are essential for identifying and rectifying issues in claim submissions. Increasing claim submissions without review risks a higher rate of denial and revenue loss, while outsourcing all denials to third-party services might lead to a lack of ownership and understanding of the specific reasons for denials, which is contrary to improving internal processes. Thus, focusing on process improvement and education directly supports the goal of reducing denials and enhancing recovery