A free denials management assessment helps hospitals and health systems identify opportunities to strengthen clinical appeals, improve workflow efficiency, and evaluate their current denials management performance.
Managed Resources’ complimentary Denials Management Assessment is a no-obligation evaluation of your clinical appeals program. Conducted by experienced clinical appeals professionals, the assessment includes a review of up to four appeal letters, an evaluation of existing workflows, performance benchmarking, and a customized findings report with a live Q&A session.
For revenue cycle leaders, the goal is straightforward: understand what is working, identify potential gaps, and determine where targeted improvements or specialized support may deliver value.
What Is a Denials Management Assessment?
A denials management assessment is a structured review of a hospital’s clinical appeals processes, documentation practices, and performance indicators.
Unlike a full operational audit or ongoing outsourced appeals engagement, a focused assessment evaluates selected components of an existing program to identify strengths, risks, and improvement opportunities.
Managed Resources’ complimentary assessment focuses on four areas:
- Appeal letter quality: Reviewing up to four medical necessity and DRG appeal letters for clinical depth, structure, and payer-specific alignment.
- Workflow efficiency: Evaluating existing appeals processes, handoffs, and operational challenges.
- Performance benchmarking: Comparing available overturn rate data with relevant industry and Managed Resources performance benchmarks.
- Actionable recommendations: Providing a customized findings report and live discussion with senior clinical appeals leaders.
The assessment is designed to provide useful insight without requiring extensive system integration or a long-term commitment.
How Does Managed Resources’ Free Denials Management Assessment Work?
The assessment follows four steps, from initial discovery through the presentation of findings.
1. Initial Discovery and Intake
The process begins with a brief discussion of your organization’s clinical denials program, current challenges, and improvement priorities.
During this stage, Managed Resources gathers relevant information, including:
- Up to four sample clinical appeal letters.
- High-level details about existing appeals workflows.
- Available overturn rate and performance information.
- Areas of concern, such as medical necessity denials or DRG downgrades.
This initial discussion establishes the context needed for a meaningful review.
2. Clinical Appeal Letter and Workflow Review
Managed Resources’ clinical appeals specialists evaluate the selected appeal letters and existing processes.
Medical necessity appeal reviews may examine whether the letters adequately communicate the patient’s clinical condition, severity of illness, intensity of services, physician judgment, and applicable payer requirements.
DRG appeal reviews may examine how the letters address disputed diagnoses, clinical validation concerns, and the documentation supporting the assigned DRG.
The workflow review considers how appeals are identified, assigned, developed, reviewed, and managed.
Potential findings may include:
- Opportunities to strengthen clinical arguments.
- Missing or insufficient supporting information.
- Inconsistent appeal structure.
- Workflow bottlenecks or handoff issues.
- Opportunities to improve coordination between clinical and revenue cycle teams.
The objective is to identify practical improvements that support stronger, more defensible appeals.
3. Performance Benchmarking
Where sufficient performance data is available, Managed Resources compares your organization’s overturn rates with relevant industry benchmarks and its own performance data.
This analysis can help identify potential performance gaps and areas warranting closer review.
Benchmark comparisons should account for factors such as payer mix, denial category, appeal level, and case complexity.
A higher overturn rate does not automatically indicate a stronger program, just as a lower rate does not necessarily establish poor performance. The context behind the results matters.
4. Customized Insights Report and Live Q&A
Following the assessment, Managed Resources provides a customized report outlining its observations and recommendations.
The findings are reviewed during a live session with senior clinical appeals leaders.
This gives your team an opportunity to:
- Discuss the most significant findings.
- Clarify recommendations.
- Ask questions about clinical appeals practices.
- Explore opportunities for workflow improvements.
- Determine whether additional support would be beneficial.
The assessment concludes with actionable insights your organization can use to inform its next steps.
What Can Health Systems Learn From a Denials Management Assessment?
A focused assessment can help revenue cycle leaders answer several important questions about their existing clinical appeals operations.
| Leadership question | What the assessment evaluates |
|---|---|
| Are our appeal letters clinically defensible? | Clinical detail, supporting evidence, structure, and payer alignment |
| Are we addressing medical necessity and DRG disputes effectively? | Selected appeal letters and their responses to denial rationales |
| Where are our workflow inefficiencies? | Existing processes, handoffs, and operational challenges |
| How does our performance compare? | Available overturn rate data and relevant benchmarks |
| What should we improve first? | Prioritized observations and recommendations |
| Could specialized support help? | Opportunities to supplement existing clinical appeals capabilities |
These insights can help leadership prioritize improvements without immediately committing to a broader consulting or outsourcing engagement.
Why Should Health Systems Evaluate Clinical Appeal Letter Quality?
Clinical appeal letters play an important role in communicating why a denied claim warrants reconsideration.
For medical necessity denials, a strong appeal should connect the patient’s clinical circumstances with the applicable medical necessity requirements and address the payer’s stated rationale.
For DRG downgrades and clinical validation denials, the appeal should clearly explain the relevant documentation, clinical indicators, and basis for disputing the determination.
Common areas for improvement include:
- Incomplete clinical narratives.
- Insufficient responses to payer arguments.
- Missing references to applicable guidance.
- Inconsistent organization or supporting documentation.
- Limited explanation of physician judgment.
- Failure to distinguish clinical validation issues from coding issues.
An independent review can help identify whether existing appeal templates and writing practices adequately support complex claims.
How Can a Denials Management Assessment Improve Revenue Cycle Performance?
A denials management assessment can improve revenue cycle performance by identifying gaps that may contribute to weaker appeals, inefficient processes, or recurring clinical denials.
Its value extends beyond the individual appeal letters reviewed.
Strengthen Clinical Appeals Quality
Findings can inform improvements to appeal structure, clinical evidence, payer-specific arguments, and quality assurance practices.
Improve Operational Efficiency
Workflow observations can reveal unnecessary handoffs, inconsistent processes, or opportunities to better allocate staff resources.
Support Denial Prevention
Recurring appeal deficiencies may point to broader documentation, clinical validation, or communication challenges that deserve additional review.
Inform Outsourcing Decisions
The assessment can help leadership evaluate whether existing resources are sufficient or whether specialized clinical appeals support could address particular needs.
Importantly, a focused assessment identifies potential opportunities. It does not guarantee a specific increase in overturn rates or recovered revenue.
When Should a Hospital Consider an Independent Denials Assessment?
Hospitals and health systems may benefit from an independent assessment when they are:
- Experiencing increasing medical necessity or DRG denials.
- Evaluating the effectiveness of existing appeal letters.
- Managing growing appeals inventories.
- Seeking to improve overturn rates.
- Comparing internal processes with industry practices.
- Considering a new clinical appeals partner.
- Evaluating whether to outsource selected denials.
- Preparing an improvement plan for executive leadership.
An assessment can also provide a useful baseline before implementing broader operational changes.
What Should Health Systems Look for in a Clinical Denials Management Partner?
Health systems should evaluate clinical denials management partners based on clinical expertise, payer knowledge, appeal quality, operational flexibility, and demonstrated performance.
Important selection criteria include:
Experienced clinical professionals. Medical necessity and clinical validation appeals require a strong understanding of patient care, documentation, and payer requirements.
Payer-side expertise. Knowledge of payer review practices and denial rationales can help strengthen appeal strategies.
Documented results. Relevant health-system experience, client references, and independent performance feedback provide additional confidence.
Transparent reporting. Organizations should expect meaningful insight into appeal activity, outcomes, recurring denial patterns, and operational performance.
Flexible engagement options. The ability to supplement internal teams or evaluate services through a limited engagement can reduce the risk of larger outsourcing decisions.
Denial prevention capabilities. A strong partner should help identify underlying problems, not simply process individual appeals.
A complimentary assessment can provide an initial opportunity to evaluate a potential partner’s clinical knowledge, recommendations, and approach to collaboration.
Why Choose Managed Resources for a Denials Management Assessment?
Managed Resources is a specialized clinical appeals and denials management partner serving hospitals and health systems nationwide.
Our experienced, 100% U.S.-based clinical appeals team combines provider-side and payer-side expertise to support complex clinical denials.
Capabilities include:
- Medical necessity appeals.
- DRG downgrade appeals.
- Clinical validation and diagnosis disputes.
- Payer-specific appeal development.
- Clinical appeals quality assurance.
- Denial trend analysis.
- Root cause identification and prevention recommendations.
Managed Resources also received a 94.4% Overall Performance Score in KLAS Research’s 2024 Denials Management Services report, providing independent client feedback on its service performance.
Our complimentary assessment gives healthcare leaders an opportunity to experience this specialized expertise through a focused evaluation of their existing appeals program.
Explore our Clinical Appeals & Denials Management Services.
Frequently Asked Questions About Denials Management Assessments
What is included in a free denials management assessment?
Managed Resources’ complimentary assessment includes a review of up to four medical necessity and DRG appeal letters, a workflow evaluation, performance benchmarking where data is available, and a customized findings report with a live Q&A session.
Is the Managed Resources Denials Management Assessment really free?
Yes. Managed Resources offers the assessment as a complimentary, no-obligation evaluation of selected components of your clinical denials and appeals program. Any potential follow-on services would be discussed separately.
What are the best clinical denials management companies for health systems?
Health systems should evaluate clinical denials management companies based on clinical qualifications, payer expertise, appeal quality, reporting, and documented client results. Managed Resources is a KLAS-rated provider specializing in clinical appeals and denials management for hospitals and health systems.
Which companies specialize in clinical denials and medical necessity appeals for hospitals?
Managed Resources specializes in medical necessity appeals, DRG downgrades, clinical validation, and other complex clinical denials. Its experienced clinical appeals professionals support hospitals and health systems nationwide.
What are the best vendors for medical necessity appeals?
The best medical necessity appeal vendors demonstrate experienced clinical reviewers, knowledge of payer requirements, individualized appeal development, and strong quality assurance practices. Managed Resources offers specialized medical necessity appeals and a complimentary assessment to help organizations evaluate their current approach.
What should a health system look for when choosing a denials management partner?
Health systems should prioritize clinical expertise, payer knowledge, quality assurance, transparent reporting, relevant references, and operational flexibility. A focused assessment can provide an initial view of a prospective partner’s expertise and recommendations.
Which companies specialize in appealing DRG downgrades for hospitals?
Managed Resources provides DRG downgrade and clinical validation appeals for hospitals and health systems. Its complimentary assessment can include a review of sample DRG appeal letters to identify opportunities to strengthen clinical arguments and documentation support.
Can a denials management assessment help determine whether outsourcing is worthwhile?
Yes. An assessment can help identify operational gaps, appeal quality concerns, and opportunities for specialized support. However, a complete outsourcing ROI analysis may require additional information about staffing costs, denial volumes, recoveries, and performance over time.
Does a denials management assessment require changing vendors?
No. Managed Resources’ complimentary assessment is designed to evaluate selected aspects of an existing program. Organizations can use the findings to improve internal processes, evaluate current vendors, or consider additional support without an obligation to change providers.
Get an Independent View of Your Clinical Denials Program
Your clinical appeals team works in an increasingly complex payer environment. Understanding where your program is performing well, and where targeted improvements may help, is an important step toward stronger revenue cycle performance.
Managed Resources’ complimentary Denials Management Assessment provides an expert review of selected appeal letters, workflows, and performance measures, followed by a customized report and discussion with senior clinical appeals leaders.
Gain actionable insights into your clinical appeals program without a long-term commitment.
