Stephanie Robinson on the art of digging into denials

WATERLOO, Iowa – HME providers that treat a billing failure as an isolated problem may fix a claim and recover a payment. But only by tracing the failure backward can they fix the system, says Stephanie Robinson, VGM’s new director of reimbursement and payer relations.

HME News: Where are providers struggling most with billing and reimbursement?

Stephanie Robinson: I think selecting the correct payer has always been a struggle for all suppliers because there's so much downstream that happens when you don't. It could be how you have your billing rules set up for who requires authorizations, because if you select the incorrect payer, your system is not going to tell you that an authorization is required and then you end up with denials that way. We've layered in a lot of automation and AI in a lot of places, and I think that that can really be a benefit if you can get that right. So, I think we have tools in our toolbox that can help with that, but it doesn't take away from what's happening.

HME: How can providers determine if a denial stems from an internal workflow problem?

Robinson: Really root-causing the denials that you’re getting from your payers and then working them backward and not just putting a Band-Aid on them or saying, “OK, let’s go resubmit this to the correct payer,” but asking the five whys. Why did that happen in the first place? Why was it sent to the wrong payer? Did we not ask enough questions of our patient? Was this payer secondary? Really dig five layers deeper into your denials and then correct the problem where it truthfully started, not just cover it up. Once you've asked why five times, you can typically get back to the root of why it happened.

HME: What are you most looking forward to accomplishing in your new role?

Robinson: I'm most excited about helping suppliers simplify what is so complex in the industry. Most of the questions I've gotten already are not about a specific black and white policy issue. It's what's in the gray. It's what's complex and it's creating decision paralysis amongst the customer service teams or billing teams. So that decision paralysis creates wait, and wait is waste.