Denials in Tasy: record, classify, appeal and measure recovery
Initial, recovered and final denials are three different numbers, and only the last is a loss. How to record denials in Tasy by item and reason, appeal on time and measure what came back.
A denial is the payer's full or partial refusal of an amount billed. The concept and its management are in hospital claim denials. This article covers the operational side: how denials in Tasy are recorded, how appeals are followed and how to separate the denial that can still come back from the one that became a loss.
The cycle
| Step | What happens | Record |
|---|---|---|
| Submission | Account sent in a batch | Batch and receivable |
| Response | The payer pays and sends the remittance with denials | Receivable settlement and denial by item |
| Classification | The hospital classifies the reason | Payer code and internal reason |
| Analysis | Billing and audit decide to appeal or accept | Decision recorded |
| Appeal | Appeal sent with evidence, on time | Date and value of the appeal |
| Outcome | Recovered (fully or partly), upheld or accepted | Final settlement |
Record by item
The denial must be recorded on the account item, not just the total. Without the item, nobody knows whether the problem is room days, supplies, fees or charges, and the appeal ends up generic. The payer's remittance lists the denied items and reason codes; the job is to bring that into Tasy, item by item.
Classify the reason
Payers use their own codes. For management, it is worth grouping them into a few categories:
| Category | Examples | Where it starts |
|---|---|---|
| Administrative | Member card, authorization, claim form, deadline | Front desk, payer relations |
| Clinical | Missing documentation, unjustified procedure, supplies without an order | Care teams, medical record |
| Contractual | Price different from the table, item not covered, package | Commercial, setup |
| Across-the-board or unclear | Denial without a specific justification | Payer |
The category says where to take the fix: administrative denials are solved at the front desk and payer relations; clinical ones, in care; contractual ones, in negotiation and price setup.
Appeal on time
Each contract sets the appeal deadline. Once it passes, the denial becomes a loss. The list of open denials by appeal deadline, by payer, is the team's most important tool. The appeal carries:
- the item and the reason disputed;
- the evidence: record, order, administration record, authorization, contract;
- an objective argument, item by item.
The three numbers
| Number | Calculation | What it shows |
|---|---|---|
| Initial denial | Amount denied on response ÷ amount sent | Quality of the account sent |
| Recovered denial | Amount that came back on appeal ÷ initial denial | Appeal efficiency |
| Final denial | Denial that stayed lost ÷ amount sent | Real revenue loss |
A high initial denial with high recovery is a process problem: the hospital works twice to collect what it was already owed. A high final denial is revenue loss. They call for different actions.
Denials and physician payouts
When the payer denies a procedure, the physician payout for that item follows the hospital's policy (reversal, hold until the appeal, or full payment). The rule must be the same for everyone and reflected in Tasy. See physician payouts from Tasy.
Denials and the books
A denial reduces revenue or the receivable, depending on the accounting policy, and a recovered denial comes back as revenue or a collection. With accounting inside Tasy, those entries follow the denial record. Without it, receivables in the trial balance differ from finance's position.
Where denials begin
The best denial management happens before submission, at account closing and in authorizations. Clic Health's denial dashboards, by payer, reason and month, are in billing and denials with Tasy data.
Who writes this
Domínio has worked for more than 20 years with hospitals that run Tasy and follows denials from submission to the accounting entry. To measure your hospital's recoverable and final denials, talk to us on WhatsApp or at comercial@dominiocontabil.com.br.
Related questions
Should every denial be appealed?
No. A valid denial (the hospital got it wrong) should be accepted and the cause fixed. Appeals are for unfounded denials, with evidence.
What is the difference between a denial and a discount?
A denial is a refusal of a billed item or amount, with a reason. A discount is a negotiated commercial condition. Mixing them distorts the KPI.
Why record denials by item?
Because the reason and the fix depend on the item: room days, supplies, fees and charges have different causes.
How do I know each payer's appeal deadline?
From the contract. Payer relations should keep a deadline table by payer.
Written by the Domínio team behind Clic Health: accountants, controllers and developers with more than 20 years of work with hospitals that run Tasy. Have a question about Tasy? Talk to us on WhatsApp.