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Cited by 32Healthcare Quality and ManagementHealthcare Operations and Scheduling OptimizationQuality and Supply Management

The DOI matches its Crossref record; 10 of the 12 references it cites were found in a registry or an index.

Enhancing Financial Performance: An Application of Lean Six Sigma to Reduce Insurance Claim Denials

Kovach, Jamison V., Borikar, Shrutika·2018·Quality Management in Health Care
DOI 10.1097/qmh.0000000000000175
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Abstract

Health systems typically lose approximately 3% to 5% of net revenues annually due to insurance claim denials. While most denials can be appealed, the administrative burden of sorting through and appealing them can be time consuming and delays the revenue collection process. This article describes how the Lean Six Sigma methodology was used to improve the revenue cycle by reducing insurance claim denials for a leading pediatric hospital in the United States. The use of this approach is demonstrated through a case example focused on reducing denials by improving the hospital's Emergency Center registration process. Multiple pilot tests were performed to ensure the proposed changes sufficiently addressed the problem of missing/incomplete insurance information. Results indicated that the revised registration form reduced missing/incomplete fields by 67%. As a result, the revised form was implemented, which helped greatly reduce insurance claim denials. In addition to providing an example from which other health systems can learn to successfully implement Lean Six Sigma to enhance the performance of their revenue cycle, this work helped the hospital in which this research was performed improve its patient experience by making it easier for patients to complete their Emergency Center registration form.

Overview

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Crossref · 10.1097/qmh.0000000000000175

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10 of 10 references verified0 citation errors · 0 not checkable

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Citations

Cites

Show all 12 references

Research works printed but not linked: 2

  1. Burns, 2016, Reducing administrative write-offs through improved denial management, Healthc Financ Manage, 70, 30
  2. Holyoak, 2017, Rethinking denial management, Health Manage Technol, 38, 20

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Metadata

Authors
Kovach, J. V., & Borikar, S.
Affiliations
University of Houston (US)
Corresponding author
Kovach, Jamison V.
ORCID
Kovach, Jamison V.
Venue
Quality Management in Health Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-07
Volume
27
Issue
3
Pages
165-171
ISSN
1063-8628 (ISSN-L)
DOI
10.1097/qmh.0000000000000175
OpenAlex
W2912930408
Cited by
32
References
12
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 16 · 2021: 3 · 2019: 1
FWCI
1.27
Type
journal article
Language
en
Open access
closed
Locations
  • Quality Management in Health Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
  • Social Sciences › Business, Management and Accounting › Management Information Systems › Quality and Supply Management
Keywords
insurance denials, Lean Six Sigma, hospital revenue cycle, children's hospitals, patient experience
MeSH terms
Emergency Service, Hospital, Humans, Insurance Claim Review, Insurance, Health, Pilot Projects, United States, Efficiency, Organizational, Quality Improvement

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Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.