Scenario:

David, a student from an accredited HIM program, was given a professional practice experience project that required him to review reimbursement denials for Medicare patients over the course of the past year. He noticed that the denials were higher when the claim included services from the radiology department. He researched the claims and resubmitted them with additional documentation. Through this process, he discovered that the additional documents required were similar for each claim. Also, because of the settings on the organization's EHR, the required diagnosis codes for the radiological services performed were not being submitted on the claim form, although the procedure code was included on the claim. David communicated his findings to the manager, and they discussed potential next steps.

Your initial posting must address ALL three questions.

1. What could cause a denial from an insurance company?
2. Based on your readings in the textbook recommend a minimum of TWO suggestions for process improvement to help improve the efficiency of the revenue cycle management.
3. Which departments are responsible for the revenue cycle problems at this company?