Productivity Standards for Denials
Hi, has anyone developed productivity standards/expectations for denials? I've heard anywhere from 30 min to 1 hour to 2 hours per denial..
Hi, has anyone developed productivity standards/expectations for denials? I've heard anywhere from 30 min to 1 hour to 2 hours per denial..
Comments
I have researched multiple consulting companies and hospital networks. When surveying you need to be careful you are comparing apples to apples. You must question who is doing the review, a CCS? and/or RN/CDS? and does their role also include all the administrative tasks such as filing, sending and documenting the appeal or accept in your system. We average 2 hours per case, that covers some that take 20-30 min (a quick review and accept) and some that take 3+ hours (appeal and sometime supporting research). We allow another 1/2 hour for filing, sending, and recording the information in our audit management system. We have developed appeal templates for many of our common DX targets.
Typically 1-3 hours. If it's only 1 denied diagnosis, it can be done quickly, but when cases have up to 5 denied diagnoses, it can take a lot longer.