Overview of Denial Management: How Understanding, Strategizing, and Preventing Denials Can Boost Your RCM

When commercial payers deny medical claims, it takes a bite out of a healthcare organization’s annual revenue. According to Modern Healthcare, this loss, nationwide, totals to an estimated $262 billion. Today, claim denials are a significant contributor to the myriad of financial/net revenue challenges that have impacted US hospitals, healthcare providers, and patients alike.

Denial Management: Why Healthcare Providers are Struggling

With many healthcare organizations transitioning from a fee-for-service to value-based-care payment model, some recent market trends have spiked the urgency of such facilities to enhance their denial management processes. Struggling to collect outstanding payments and rework denied claims, organizations are facing more challenges than ever as they attempt to ground denial management, decrease overhead, and re-boost their revenue cycles.

Rethinking Denials Management: How Data Analytics Can Boost Revenue

In the modern landscape of technologically-supported, value-based healthcare, many providers have reoriented focus on their claims denials management program. The efficiency of those programs, however, can vary significantly across organizations; the effect of denied and delayed rendered claims can be detrimental to the bottom line of healthcare facilities who lack a strategic, holistic approach. An insufficient claims system can cause net revenue losses, increase operating costs, and bog clinicians down with unnecessary administrative tasks.