Using computerized physician order entry to decrease insurance denials

Insurance denials delay payments for tests to medical institutions and can decrease patient satisfaction due to unexpected billing. Our institution utilizes an ambulatory electronic health record (EHR) for routine clinical care that includes computerized physician order entry (CPOE). At our institution as well as others, considerable cost is associated with inappropriate diagnostic coding of needed procedures and tests by the physician. We developed a series of CPOE alerts and order sets targeting specific tests to address this problem. As a result, preliminary data shows that insurance denials fell by up to 37% for the targeted tests.