Healthcare Connection

Healthcare Connection – Feb. 7, 2017

5 Operational Strategies for Managing Clinical Denials

Clinical denials can be very costly and more difficult to resolve than technical denials, and they pose a higher risk of affecting net revenue. Healthcare organizations that take proactive steps to address and improve operations can reduce occurrences of clinical denials and, consequently, collect net revenue that might otherwise be lost. This article provides five operational strategies for preventing clinical denials or addressing them should they occur.

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The Front-Line ACO Audit: The Next Generation of Risk Coverage

The increase in accountable care organizations (ACOs) driven by the Affordable Care Act and the focus on value rather than volume requires healthcare internal auditors to integrate accountable care risk and compliance monitoring into their activities. This article offers information to help auditors plan for a front-line ACO audit and reveals areas that should be addressed.

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Brian B. Sanderson
Managing Principal, Healthcare Services