A Six Sigma Approach to Denials Management
Student / New to Profession
Stanly Regional has had a major problem with insurance claims being denied. These denials require investigation and rework and cause a substantial loss of revenue. This project offers a Six Sigma approach to reducing the volume of insurance denials and ultimately increasing revenue.
- - In November 2007, the Revenue Cycle Team at Stanly Regional Medical Center was tasked with reducing the number of payer denials.
- - The baseline Denials/Charges ratio was 5.47%.
- - The Six Sigma DMAIC Methodology was utilized to minimize the quantity of denials and reduce the Denials/Charges ratio.
- - The Denials/Charges ratio (3 month average) decreased to 4.12% (as of May 2008), resulting in an annualized savings of nearly $1.6 million.
- - We are still working toward sustaining improvement and our Denial/Charges ratio goal of less than 2.0%.