Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Melanie Brewer

Second Advisor

Dr. Corinne Cochran

Abstract

Insurance denials resulting from non-standardized documentation and communication gaps in the prior authorization process adversely impacted financial performance and patient care within the electrophysiology (EP) department of a large Midwest academic medical center. High denial rates for costly procedures revealed a need for improved alignment with payer medical necessity criteria. This quality improvement (QI) project aimed to enhance provider documentation, reduce denials, improve care delivery, and increase revenue by implementing standardized documentation templates. A review of the literature supports that standardized documentation and clinical decision support tools enhance consistency, reduce errors, and improve prior authorization success rates. Guided by the Plan-Do-Study-Act (PDSA) model and OhioHealth’s Organizational Change Management (OHCM) framework, standardized smart phrase templates were developed and embedded into the electronic medical record (EMR). Sixteen providers received training, and implementation was supported through weekly feedback and data monitoring over a 12-week period. Outcomes included a 49% reduction in denials (from 69 to 34 cases), increased provider compliance (81% by week 12 and 100% by week 21), and $2.38 million in recovered revenue. The intervention has been sustained through permanent EMR integration and planned quarterly audits. This initiative highlights the critical leadership role of advanced practice nurses in documentation optimization, promoting timely care, financial stewardship, and alignment with the IHI Triple Aim and Institute of Medicine’s Six Aims.

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