Preventing Denials: Nursing and Finance Partner to Achieve Best Practice in the Authorization and Payment

2.50
Hdl Handle:
http://hdl.handle.net/10755/182232
Category:
Abstract
Type:
Presentation
Title:
Preventing Denials: Nursing and Finance Partner to Achieve Best Practice in the Authorization and Payment
Author(s):
McFadden, Alex
Author Details:
Alex McFadden, MPA, Director Patient Financial Services/Patient Access, West Virginia University Hospitals, Morgantown, West Virginia, USA, email: mcfaddena@wvuh.com
Abstract:
Podium presentation, ANCC National Magnet Conference: One of the growing challenges facing hospitals today is the process of denials management. The denial for payment of claims was once thought of as a finance issue. This presentation will bring to focus how nursing and finance must collaborate to not only optimize reimbursement, but truly coordinate the authorization of services from pre-service to post-discharge to benefit the organization and the patient. By indentifying and implementing a quality improvement process we have been able to obtain a best practice approach with outcomes to track our success. We have changed the culture of our organization from reactive to proactive by utilizing Transformational Leadership to develop synergistic roles between nursing and finance. We bring the nurse and the CFO to the same table as an advocate for the patient. By using data analysis and an outcomes approach, we have developed tools and spreadsheets that identify emerging issues and trends that will be shared throughout this presentation. An outline of organizational strategies and policy changes that impact this complicated process will be discussed. The presentation will utilize specific case studies to address barriers to appropriate discharge planning that not only affect reimbursement, but impact level of care, length of stay, and avoidable days. An autonomous process that establishes communication directly between an RN and a Patient Financial Services Representative to quickly respond to denial issues without going through layers of management will be presented. Concluding discussion will include the organizational strategy developed that consistently helps us meet monthly dashboard targets.
Repository Posting Date:
28-Oct-2011
Date of Publication:
28-Oct-2011
Conference Date:
2010
Conference Name:
ANCC National Magnet Conference
Conference Host:
American Nurses Credentialing Center
Conference Location:
Phoenix, Arizona, USA
Description:
The 14th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 13-15 October, 2010 at the Phoenix Convention Center in Phoenix, Arizona, USA.
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titlePreventing Denials: Nursing and Finance Partner to Achieve Best Practice in the Authorization and Paymenten_GB
dc.contributor.authorMcFadden, Alexen_US
dc.author.detailsAlex McFadden, MPA, Director Patient Financial Services/Patient Access, West Virginia University Hospitals, Morgantown, West Virginia, USA, email: mcfaddena@wvuh.comen_US
dc.identifier.urihttp://hdl.handle.net/10755/182232-
dc.description.abstractPodium presentation, ANCC National Magnet Conference: One of the growing challenges facing hospitals today is the process of denials management. The denial for payment of claims was once thought of as a finance issue. This presentation will bring to focus how nursing and finance must collaborate to not only optimize reimbursement, but truly coordinate the authorization of services from pre-service to post-discharge to benefit the organization and the patient. By indentifying and implementing a quality improvement process we have been able to obtain a best practice approach with outcomes to track our success. We have changed the culture of our organization from reactive to proactive by utilizing Transformational Leadership to develop synergistic roles between nursing and finance. We bring the nurse and the CFO to the same table as an advocate for the patient. By using data analysis and an outcomes approach, we have developed tools and spreadsheets that identify emerging issues and trends that will be shared throughout this presentation. An outline of organizational strategies and policy changes that impact this complicated process will be discussed. The presentation will utilize specific case studies to address barriers to appropriate discharge planning that not only affect reimbursement, but impact level of care, length of stay, and avoidable days. An autonomous process that establishes communication directly between an RN and a Patient Financial Services Representative to quickly respond to denial issues without going through layers of management will be presented. Concluding discussion will include the organizational strategy developed that consistently helps us meet monthly dashboard targets.en_GB
dc.date.available2011-10-28T15:14:59Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T15:14:59Z-
dc.conference.date2010en_US
dc.conference.nameANCC National Magnet Conferenceen_US
dc.conference.hostAmerican Nurses Credentialing Centeren_US
dc.conference.locationPhoenix, Arizona, USAen_US
dc.descriptionThe 14th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 13-15 October, 2010 at the Phoenix Convention Center in Phoenix, Arizona, USA.en_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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