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Introduction
We recently hosted a webinar called “A Groundbreaking Strategy to Overcoming Healthcare Denials,” where Dr. Terrance Govender, our VP of Medical Affairs, delivered a bold message: healthcare has spent billions hunting for documentation fixes in the chart when the answer starts with the physician.
This webinar session challenged the status quo of denial management and presented a case for proactive clinical engagement over reactive appeals. At a time when hospitals are grappling with rising denial rates, physician burnout, and diminishing returns on documentation interventions, this message couldn't be more relevant. Here's what we learned.
👉 Watch the full webinar to hear directly from Dr. Terrance Govender
Key Takeaways
1. Insufficient Documentation Is a Clinical Problem
Insufficient documentation is often treated as a back office headache, yet it originates in clinical decision making. As Dr. Govender emphasized:
“The denial… is not just a revenue problem. It's a documentation clarity issue, which inevitably is a clinical problem first.”
He illustrated how organizations often avoid reporting legitimate conditions like malnutrition due to fear of payer denials, even when data shows patients clearly have the condition. This under-reporting impacts both revenue and patient outcomes.
2. Retrospective Queries Rarely Change Behavior
Traditional CDI 1.0 relies on retrospective chart reviews and administrative queries, which rarely change behavior.
“The physician who engages with your documentation query never ends that engagement thinking, ‘They were trying to help me get better at diagnosing.’” - Dr. Govender
Instead, physicians perceive these interactions as compliance checks rather than educational or clinical guidance. The result? Poor engagement and continued documentation variability. Rather than treating queries as the end goal, we should use them as a temporary safety net while focusing on helping physicians improve at the source.
3. Turn the Administrative Task Into a Clinical Ask
Instead of asking physicians to hunt for severity in the medical record, start empowering them to find it in the patient. Give them concise lists of underreported conditions and unified clinical definitions. When clinicians document in real time, using criteria they helped define, behavior shifts, often within three months.
4. Enforce Shared Clinical Definitions
Definitions alone are not enough; enforcement is non-negotiable. Without alignment, three physicians may document the same condition (e.g., AKI) using entirely different criteria. This variation:
- Fuels denials
- Compromises outcomes tracking
- Introduces compliance risk
“Every time a physician agrees with a query on a condition for which they are not proficient in your approved definition, it’s a compliance risk.” - Dr. Govender
Removing that variation, through training, alignment, and enforcement, is the only way to close gaps in documentation and reduce denials long-term.
5. Build a Lean, Physician-Led Denial Prevention Model
Rather than continuing to invest in the costly appeals infrastructure, ClinIntell's model takes a proactive approach: identify high‑value, under-reported conditions and equip physicians, upstream, with the data, definitions, and accountability they need to document accurately from the start.
“This isn’t about getting better at appeals. It’s about getting the documentation right before the denial ever happens.” - Dr. Govender
The result? Fewer queries, higher compliance, better care, and lower physician burnout.
Conclusion
The solution isn’t more charts, queries, or appeals; it’s a structural shift in how we engage clinicians. By treating documentation as a clinical behavior, not a clerical burden, organizations can finally break the denial cycle.
👉 Watch the full webinar to hear directly from Dr. Terrance Govender
👉 Explore success stories and innovative insights on our ClinIntell Resources and Blogs
👉 Want to learn more about the ClinIntell approach? Get in touch with our team
Extra Resources
Case Mix Index Analysis – Free Personalized Demo
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