Questions to ask any Denials & Appeals vendor

Every vendor in this category demos well. These are the questions that separate a product that will work on your volume, payer mix, and staff from one that works in the sales deck. Take them into the demo.

1. 1

   What is your overturn rate by denial category, and how is it measured?

2. 2

   Do you prevent denials upstream or only work them after they land?

3. 3

   How are appeal letters generated and evidenced from the chart and payer policy?

4. 4

   What denial categories will you not work, and what happens to them?

5. 5

   Is pricing contingency on recoveries, per appeal, or platform fee, and what is the effective rate?

6. 6

   How do findings feed back to registration, coding, and CDI so the same denial stops recurring?

7. 7

   What volume commitments do you need to staff or model our inventory?

8. 8

   Can we see recovered-dollar results from a customer with our payer mix?