At the August 2022 ACDIS Physician Advisor Exchange, physician advisors explored new denial patterns, emerging challenges, and opportunities for improvement during three discussion panels on Denials Management and Quality, led by Rebecca Hendren, ACDIS director of programming. Physician advisors identified six top areas of concern:
Higher-than-usual denial volumes and denial batching Confusing, arbitrary payer rules and criteria Egregious auditor behavior Shortage of qualified appeals writers Health plan megamergers that wield more power Lack of political will to change payer behavior
The panel also weighed in on physician advisors’ evolving roles, looking at how they allocate time for various denials management efforts, including attending Administrative Law Judge (ALJ) hearings and addressing documentation, contracting, and peer-to-peer responsibilities. Below is a summary of these discussions.
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