Gartner Research

Healthcare CIOs: Build Next-Level RCM Performance With a Proactive Denials Management and Avoidance Strategy

Published: 14 October 2019

Summary

U.S. healthcare providers face mounting operational costs and revenue risk due to preventable high-cost claims denials. CIOs must use RCM technology, governance and analytics to improve their denials’ success rate and head off any undermining issues at the point of origin.

Included in Full Research

  • CFOs’ Revenue Demands Push CIOs to Optimize RCM
  • Create an Enterprisewide DMA Strategy
  • Recommendations
    • Execute Your DMA Strategy in Four Steps
    • Step 1: Optimize RCM IT Systems by Mapping All Denial Codes
    • Step 2: Establish a Revenue Cycle Transformation Operating Committee to Move From a Sustainability to a Growth Model
    • Step 3: Use Descriptive Data Analytics to Identify Denials Trends and Root Cause
    • Step 4: Use Predictive Analytics as a Force Multiplier for Denials Forecasting and Proactively Preventing Denials

Analysts:

Sachin Dev

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