Commit to a Denial-Prevention PDSA
Commit to a one-week PDSA test that prevents one recurring denial category upstream.
Run one denial-prevention PDSA for a recurring claim denial category. Revenue-cycle workflow: eligibility failures, missing referrals, invalid member IDs, missing modifiers, prior-auth gaps, or incomplete documentation before claim submission. For one week, I will test [specific upstream change] for [denial category/payer/visit type]. Aim: reduce [denial reason] before claim submission. Measure: [count or percent] of defects caught upstream and [denials/rework] after submission. Prediction: [what I expect]. Review date: [date]. Next decision: adopt, adapt, or abandon. In 3 days, check whether the denial category, test population, upstream change, measure, and review date are written down and the first test has started. Next…
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