The Better Outcomes Show
111: Why you Struggle with Insurance Denials
Do you or your colleagues struggle with insurance denials?
It seems that, at least more recently, I keep hearing from clinicians and managers that more insurance companies and managed care organizations require peer to peer reviews for continued authorization. This sometimes results in insurance denials for continued authorization or denials of claims that are being appealed. We’ve noticed this as well at the clinic that I own & operate. Many of our payers have shifted to using authorization portals to determine which visits/cases to approve or disapprove.
So, this week, I’m sharing a conversation I had with Johanna Metzger, a physical therapist who owns a private practice (thenourishednestpt.com). But, prior to that, she spend seven years as an insurance reviewer for insurance companies in the commercial, workman’s compensation, and medicare advantage space. She has spent time on both ends of a “peer review call”, and she shares insights from her time and experience in her role as a reviewer.
What we cover in this Episode:
- The disconnect between clinician documentation and insurance or payer’s needs
- The different value perspectives of various stakeholders in healthcare
- Leveraging data to improve clinical documentation and decrease insurance denials
- Defining value in your clinical documentation
- Understanding who your audience is when writing a clinical note
- Not only delivering, but effectively documenting high-value care and services in healthcare
- Achieving Better Outcomes and fewer insurance denials by sticking to some fundamental principles of clinical documentation
We’re starting to create videos of certain podcast episodes, including this episode, which can find on the YouTube Channel.
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For More:
If you enjoyed this episode: Join Rafael E. Salazar II, MHS, OTR/L (Rafi), principal of Rehab U Practice Solutions and host of The Better Outcomes Show as he explores the possibilities of a new healthcare. Guests range from clinicians trying new techniques and treatments to executives and entrepreneurs exploring new service delivery methods, business models, and organizational structures. You can sign-up to receive new episodes delivered directly to your inbox by filling out the form below. Learn more about Rehab U Practice Solutions by reading The Manifesto for a New Healthcare, or listen to Episode 000. Or, grab a copy of the book: Better Outcomes: A Guide to Humanizing Healthcare.
Are You Ready to Humanize Healthcare?
If you run an innovative healthcare company and are looking to develop a strategy that leverages best practices, new technology, and marketing/messaging in a way that returns the focus of healthcare to people, please reach out. I’d love to talk with you about how Rehab U Practice Solutions can help help you craft an business development strategy that leverages positioning, market research, UVP stakeholder alignment to drive business development strategy for specific healthcare stakeholders.
Rafael E. Salazar II, MHS, OTR/L (Rafi) is the Principal Owner of Rehab U Practice Solutions and the host of The Better Outcomes Show and the author of Better Outcomes: A Guide to Humanizing Healthcare. His career trajectory includes 10+ years of experience in healthcare management, clinical operations, programmatic development, marketing & business development. He even spent some time as an Assistant Professor in a Graduate Program of Occupational Therapy and has served on numerous boards and regulatory committees. He has worked on projects ranging from patient engagement initiatives to marketing communication campaigns to a multi million dollar project assisting the State of Georgia’s Department of Behavioral Health and Developmental Disabilities transition individuals out of state institutions to community residences. His work on Telehealth has been discussed in Forbes.
Today, Rafi helps innovative healthcare companies like technology startups, platforms, and SaaS companies develop effective positioning strategy and business development plans through his consulting work. He also leverages his experience as a professor and academic to speak and train on the topics around humanizing the healthcare experience. In addition, Rafi also owns and operates ProActive Rehabilitation & Wellness, a multidisciplinary outpatient clinic treating patients with musculoskeletal pain.
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Work With Me
If you are an innovative healthcare company looking to humanize healthcare through direct service delivery, technology, a device, or software, then reach out. We’d love to talk with you about how Rehab U Practice Solutions can help.
What we can help you do:
✅ Clarify your product, service, or organization’s positioning…
✅ Identify what is most valuable and least valuable to your targeted healthcare stakeholder…
✅ Develop a Market Penetration Roadmap to align your company’s value proposition with your targeted healthcare stakeholder to develop a bottom up marketing strategy…
We help you not only craft your positioning strategy, we help you identify your highest value offer for your target audience, align that value with your market, and help you develop a business development system that leverages insights from market data & industry-specific resources to enable your business development team to effectively drive business for your organization.
In short, we help your whole organization become focused on the most important thing in healthcare: people – the people who work for your organization, and the people who your organization treats or serves.
The post 111: Why you Struggle with Insurance Denials appeared first on Rehab U Practice Solutions.
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