{"id":"https://openalex.org/W2912930408","doi":"https://doi.org/10.1097/qmh.0000000000000175","title":"Enhancing Financial Performance: An Application of Lean Six Sigma to Reduce Insurance Claim Denials","display_name":"Enhancing Financial Performance: An Application of Lean Six Sigma to Reduce Insurance Claim Denials","publication_year":2018,"publication_date":"2018-06-26","ids":{"openalex":"https://openalex.org/W2912930408","doi":"https://doi.org/10.1097/qmh.0000000000000175","mag":"2912930408","pmid":"https://pubmed.ncbi.nlm.nih.gov/29944629"},"language":"en","primary_location":{"id":"doi:10.1097/qmh.0000000000000175","doi":"https://doi.org/10.1097/qmh.0000000000000175","is_oa":false,"landing_page_url":"https://doi.org/10.1097/qmh.0000000000000175","pdf_url":null,"source":{"id":"https://openalex.org/S2754346939","display_name":"Quality Management in Health Care","issn_l":"1063-8628","issn":["1063-8628","1550-5154"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","jufo-1","medline","norway-1","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Quality Management in Health Care","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5013764203","display_name":"Jamison V. Kovach","orcid":"https://orcid.org/0000-0003-2078-6007","observed_orcids":["https://orcid.org/0000-0003-2078-6007"]},"institutions":[{"id":"https://openalex.org/I44461941","display_name":"University of Houston","ror":"https://ror.org/048sx0r50","country_code":"US","type":"education","lineage":["https://openalex.org/I44461941"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Jamison V. Kovach","raw_affiliation_strings":["Project Management Program, College of Technology, University of Houston, Houston, Texas (Dr Kovach and Ms Borikar); and Hyve Solutions, Fremont, California (Ms Borikar)","Borikar)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Project Management Program, College of Technology, University of Houston, Houston, Texas (Dr Kovach and Ms Borikar); and Hyve Solutions, Fremont, California (Ms Borikar)","institution_ids":["https://openalex.org/I44461941"]},{"raw_affiliation_string":"Borikar)","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5031081246","display_name":"Shrutika Borikar","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I44461941","display_name":"University of Houston","ror":"https://ror.org/048sx0r50","country_code":"US","type":"education","lineage":["https://openalex.org/I44461941"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Shrutika Borikar","raw_affiliation_strings":["Project Management Program, College of Technology, University of Houston, Houston, Texas (Dr Kovach and Ms Borikar)","and Hyve Solutions, Fremont, California (Ms Borikar)","Borikar)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Project Management Program, College of Technology, University of Houston, Houston, Texas (Dr Kovach and Ms Borikar)","institution_ids":["https://openalex.org/I44461941"]},{"raw_affiliation_string":"and Hyve Solutions, Fremont, California (Ms Borikar)","institution_ids":[]},{"raw_affiliation_string":"Borikar)","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5013764203"],"corresponding_institution_ids":["https://openalex.org/I44461941"],"apc_list":null,"apc_paid":null,"fwci":1.1664,"has_fulltext":false,"cited_by_count":33,"citation_normalized_percentile":{"value":0.7824554,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":88,"max":99},"biblio":{"volume":"27","issue":"3","first_page":"165","last_page":"171"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12871","display_name":"Healthcare Quality and Management","score":0.7886000275611877,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12871","display_name":"Healthcare Quality and Management","score":0.7886000275611877,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11773","display_name":"Healthcare Operations and Scheduling Optimization","score":0.1729000061750412,"subfield":{"id":"https://openalex.org/subfields/1803","display_name":"Management Science and Operations Research"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10164","display_name":"Quality and Supply Management","score":0.011099999770522118,"subfield":{"id":"https://openalex.org/subfields/1404","display_name":"Management Information Systems"},"field":{"id":"https://openalex.org/fields/14","display_name":"Business, Management and Accounting"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/insurance-denials","display_name":"insurance denials","score":0.921999990940094},{"id":"https://openalex.org/keywords/lean-six-sigma","display_name":"Lean Six Sigma","score":0.953000009059906},{"id":"https://openalex.org/keywords/hospital-revenue-cycle","display_name":"hospital revenue cycle","score":0.7549999952316284},{"id":"https://openalex.org/keywords/children-s-hospitals","display_name":"children's hospitals","score":0.8579999804496765},{"id":"https://openalex.org/keywords/patient-experience","display_name":"patient experience","score":0.800000011920929}],"concepts":[{"id":"https://openalex.org/C195487862","wikidata":"https://www.wikidata.org/wiki/Q850210","display_name":"Revenue","level":2,"score":0.7634462118148804},{"id":"https://openalex.org/C23119410","wikidata":"https://www.wikidata.org/wiki/Q236908","display_name":"Six Sigma","level":3,"score":0.6225205063819885},{"id":"https://openalex.org/C2778139897","wikidata":"https://www.wikidata.org/wiki/Q6509447","display_name":"Lean Six Sigma","level":4,"score":0.5466391444206238},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.5301643013954163},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5236004590988159},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.4838758707046509},{"id":"https://openalex.org/C111696304","wikidata":"https://www.wikidata.org/wiki/Q2303697","display_name":"Sorting","level":2,"score":0.4374350607395172},{"id":"https://openalex.org/C18762648","wikidata":"https://www.wikidata.org/wiki/Q42213","display_name":"Work (physics)","level":2,"score":0.4249809980392456},{"id":"https://openalex.org/C21547014","wikidata":"https://www.wikidata.org/wiki/Q1423657","display_name":"Operations management","level":1,"score":0.4084000289440155},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.356570303440094},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.33778291940689087},{"id":"https://openalex.org/C137335462","wikidata":"https://www.wikidata.org/wiki/Q380772","display_name":"Lean manufacturing","level":2,"score":0.2882038950920105},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.22278782725334167},{"id":"https://openalex.org/C162853370","wikidata":"https://www.wikidata.org/wiki/Q39809","display_name":"Marketing","level":1,"score":0.1572973132133484},{"id":"https://openalex.org/C127413603","wikidata":"https://www.wikidata.org/wiki/Q11023","display_name":"Engineering","level":0,"score":0.13423267006874084},{"id":"https://openalex.org/C78519656","wikidata":"https://www.wikidata.org/wiki/Q101333","display_name":"Mechanical engineering","level":1,"score":0.0},{"id":"https://openalex.org/C199360897","wikidata":"https://www.wikidata.org/wiki/Q9143","display_name":"Programming language","level":1,"score":0.0},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D004636","descriptor_name":"Emergency Service, Hospital","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D004636","descriptor_name":"Emergency Service, Hospital","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007345","descriptor_name":"Insurance Claim Review","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":false},{"descriptor_ui":"D007345","descriptor_name":"Insurance Claim Review","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true},{"descriptor_ui":"D007348","descriptor_name":"Insurance, Health","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":false},{"descriptor_ui":"D007348","descriptor_name":"Insurance, Health","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D010865","descriptor_name":"Pilot Projects","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017598","descriptor_name":"Efficiency, Organizational","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D058996","descriptor_name":"Quality Improvement","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true}],"locations_count":2,"locations":[{"id":"doi:10.1097/qmh.0000000000000175","doi":"https://doi.org/10.1097/qmh.0000000000000175","is_oa":false,"landing_page_url":"https://doi.org/10.1097/qmh.0000000000000175","pdf_url":null,"source":{"id":"https://openalex.org/S2754346939","display_name":"Quality Management in Health Care","issn_l":"1063-8628","issn":["1063-8628","1550-5154"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","jufo-1","medline","norway-1","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Quality Management in Health Care","raw_type":"journal-article"},{"id":"pmid:29944629","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/29944629","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Quality management in health care","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.766700029373169,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":12,"referenced_works":["https://openalex.org/W35819707","https://openalex.org/W1965516122","https://openalex.org/W2020558955","https://openalex.org/W2048793746","https://openalex.org/W2053200865","https://openalex.org/W2138769869","https://openalex.org/W2149432569","https://openalex.org/W2398614101","https://openalex.org/W2463676192","https://openalex.org/W2559032636","https://openalex.org/W2563715942","https://openalex.org/W6730655307"],"related_works":["https://openalex.org/W4407139474","https://openalex.org/W2083645852","https://openalex.org/W2416353961","https://openalex.org/W7111268335","https://openalex.org/W4407590841","https://openalex.org/W2755429170","https://openalex.org/W2967465719","https://openalex.org/W2998690120","https://openalex.org/W120629995","https://openalex.org/W7096890589"],"abstract_inverted_index":{"Health":[0],"systems":[1,150],"typically":[2],"lose":[3],"approximately":[4],"3%":[5],"to":[6,13,53,100,142,153,159,188],"5%":[7],"of":[8,26,74,109,163],"net":[9],"revenues":[10],"annually":[11],"due":[12],"insurance":[14,60,111,137],"claim":[15,61,138],"denials.":[16,139],"While":[17],"most":[18],"denials":[19,62,86],"can":[20,32,151],"be":[21,33],"appealed,":[22],"the":[23,38,46,55,69,89,102,107,116,128,161,170],"administrative":[24],"burden":[25],"sorting":[27],"through":[28,79],"and":[29,36],"appealing":[30],"them":[31],"time":[34],"consuming":[35],"delays":[37],"revenue":[39,56,165],"collection":[40],"process.":[41,94],"This":[42],"article":[43],"describes":[44],"how":[45],"Lean":[47,156],"Six":[48,157],"Sigma":[49,158],"methodology":[50],"was":[51,131,176],"used":[52],"improve":[54,178],"cycle":[57],"by":[58,87,123,182],"reducing":[59,85],"for":[63,186],"a":[64,80,126],"leading":[65],"pediatric":[66],"hospital":[67,171],"in":[68,172],"United":[70],"States.":[71],"The":[72],"use":[73],"this":[75,167,174],"approach":[76],"is":[77],"demonstrated":[78],"case":[81],"example":[82,145],"focused":[83],"on":[84],"improving":[88],"hospital's":[90],"Emergency":[91,191],"Center":[92,192],"registration":[93,118,193],"Multiple":[95],"pilot":[96],"tests":[97],"were":[98],"performed":[99,177],"ensure":[101],"proposed":[103],"changes":[104],"sufficiently":[105],"addressed":[106],"problem":[108],"missing/incomplete":[110,121],"information.":[112],"Results":[113],"indicated":[114],"that":[115],"revised":[117,129],"form":[119,130],"reduced":[120],"fields":[122],"67%.":[124],"As":[125],"result,":[127],"implemented,":[132],"which":[133,147,173],"helped":[134,169],"greatly":[135],"reduce":[136],"In":[140],"addition":[141],"providing":[143],"an":[144],"from":[146],"other":[148],"health":[149],"learn":[152],"successfully":[154],"implement":[155],"enhance":[160],"performance":[162],"their":[164,190],"cycle,":[166],"work":[168],"research":[175],"its":[179],"patient":[180],"experience":[181],"making":[183],"it":[184],"easier":[185],"patients":[187],"complete":[189],"form.":[194]},"counts_by_year":[{"year":2026,"cited_by_count":1},{"year":2025,"cited_by_count":2},{"year":2024,"cited_by_count":3},{"year":2023,"cited_by_count":6},{"year":2022,"cited_by_count":16},{"year":2021,"cited_by_count":4},{"year":2019,"cited_by_count":1}],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2019-02-21T00:00:00"}