Unit 6 Annotated Bibliography

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1 Unit 6 Annotated Bibliography Assignment Mary Heinrich Purdue University Global CM 220 Dr. Fussell November 2, 2021

2 Revised Thesis: Falls Community Hospital should implement a quality assurance audit for claim denials because this will improve revenue, lower claim denials, and reduce days on the A/R report. Claim Denials: Avoiding the Avoidable. (2018, May). HealthLeaders, 21, 43. https://libauth.purdueglobal.edu/login?url=https://www.proquest.com/magazines/claim- denials-avoiding-avoidable/docview/2046128714/se-2?accountid=34544 This source explains what areas contribute the most to lost revenue and it also has suggestions for how the administration can correct the problem areas, but the author also says that we must first figure out how big the problem is (Claims Denials, 2018). I do think this source poses a challenge to my thesis because the author focuses more on medical necessity and claim scrubbing editing tools and my focus is on claim denials because of registration errors. I think this is a credible source because I found it in the PG library, and it is no more than 3 years old. I also think it is credible because the author shares information from Chris Fowler president of true bridge a billing software company. I do not see myself using this source for my essay, but it could lead me to more resources. Holyoak, John. 2017. “Rethinking Denial Management. Most Organizations Take an Administrative Approach to Managing Denials. Maybe That’s Why They’re Not Collecting as Much as They Should.” Health Management Technology 38 (2): 20–21. https://search-ebscohost-com.libauth.purdueglobal.edu/login.aspx? direct=true&db=mdc&AN=29474027&site=eds-live . This source explains different parts of the revenue cycle and how claim denials will drag a hospital down if it does not have a claims denial management program (Holyoak, 2017).

3 You start off by calculating the hospital’s error rate. The chart in figure 1 is from Relay Health Finance Network Data and it shows the percentage of each denial reason. Figure 1. As seen above the graph shows 28% of denial reasons are caused by registration/eligibility (Holyoak, 2017). I do think this is a creditable source because it came from the PG library, and it is less than 5 years old. The author is also an associate vice president of product management, McKesson Relay Health Financial. Romeo, T. (2019). The top reasons for claim denials --and how to prevent them. Medical Economics, 96(11), 35. According to (Medical Economics, 2019) claim denials are not only for registration errors but they are also being denied for outdated coding resources. This source is creditable because I found it at the PG library, and it is not over 5 years old. Another reason I feel

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4 that this source is creditable is that the author Tom Romeo is the general manager of HIT and Quanim Solutions at Quest Diagnostics. I don’t think I will use this source for my essay research, but I do believe it will lead me to better sources. Take a Proactive--aka Upfront--Approach to Manage Self-pay Revenue: Front-end strategies to prevent denials, reduce write-offs. (2018). Health Care Registration: The Newsletter for Health Care Registration Professionals, 28(1), 10–12. This source explains how many denied claims are preventable by better training for the front-end people and involving all the departments by communicating with each other (Healthcare Registration, 2018). The hospital will not be successful if all the department do not work together. This source is creditable because I found it in the PG library, and it is only 3 years old. It is also a newsletter for healthcare professionals. This would be a good source for my essay.