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Best Practices to Minimize Medical Necessity Denials

OnDemand Webinar (87 minutes)

Understand how to overcome the challenges of medical necessity denials to avoid lost time and money. Health care providers face daunting challenges in addressing increasing volumes of medical necessity denials from third party payers. Medical necessity denials are extremely costly requiring rework, investigation, and appeal, not to mention the time value of money and lost opportunities to put the monies to work in the hospital. These types of denials are pervasive, difficult to successfully challenge and result in a low recovery rate. Due to often-times low dismal recovery rates and high volume of denials, there is a strong tendency to view these denials as the cost of doing business that is simply factored into the revenue cycle. An effective approach to managing third party payer denials is to invest in the resources, education of all relevant health care stakeholders, technology, and processes to mitigate and avoid denials in the first place. There are countless contributing factors to medical necessity denials beyond the reporting of a 'non-covered' diagnosis. During this topic you will learn best practice principles and practices in the revenue cycle to minimize medical necessity denials beginning with efforts to progressively transform inefficient repetitive denials management into a cross cultural environment embracing concepts and thought processes of denials avoidance.


Glenn Krauss, B.B.A., RHIA, CCS, CCS-P, CPUR, FCS, PCS


Historic Perspective of Medical Necessity

• Local Coverage Determinations and National Coverage Determinations

• Antagonistic and Punitive Approach

• Perpetuation of the Treadmill

Evolution of Medical Necessity

• Developments of the Last Two Years

• Medical Necessity - Physician Initiative vs. Hospital Initiative

• Impact of Medical Necessity Upon Physician's Practice of Medicine

• Elements of Medical Necessity Beyond Diagnostic Tests

Medical Necessity - A Synergistic Approach

• Necessity of Collaboration Between Physician and Hospital

• Vested Financial Interest of Both Parties

• Evolving Business Financial Model - Financial Repercussions

Strategies to Promote Medical Necessity Synergies and Partnerships - Physician and Hospital

• Best Strategies to Promote Physician Education and Buy-in From Physicians

• Proven Tips to Overcome Physician Resistance and Reluctance

• Practical Advice and Guidance on Building and Expanding Upon Achieved Successes to Maintain Cultural Paradigm Shifts in Medical Necessity Mindset That Embraces Concepts of Denials Avoidance

Additional Formats

Audio & Reference ManualMore Info