8 APRIL 2025IN MY OPINIONBy Jerald M Archibeque, Director, Hospital Billing, Presbyterian Healthcare ServicesHealthcare denials are a significant challenge in the complex landscape of healthcare administration. Denials happen for various reasons, including administrative errors, lack of medical necessity, coding issues, eligibility and coordination of benefits issues, or incomplete documentation. Despite efforts to streamline processes and reduce denials, they persist at organizations nationwide, impacting providers and patients. Understanding the causes, consequences, and strategies for addressing healthcare denials is crucial for improving our patients' experience, as well as the efficiency and effectiveness of care delivery. Proactive identification and resolution of denial trends help identify root causes and prevent future denials. Collaborative efforts between healthcare providers, payers, and regulatory agencies are essential to streamline processes, reduce administrative burdens, and improve the overall efficiency and effectiveness of the healthcare system.At Presbyterian Healthcare Services, a not-for-profit Engaging clinical areas in denial resolutionJerald Archibeque, director of hospital billing at Presbyterian Healthcare Services, has spent 25 years in revenue cycle operations for health systems. Presbyterian's Revenue Cycle team is a seven-time winner of the HFMA MAP award, which recognizes hospitals, health systems, and physician practices that meet industry standard revenue cycle benchmarks.Jerald M Archibeque
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