While healthcare reform has received a lot of attention in American policy in recent years, the healthcare industry continues to face challenges. Healthcare providers give top priority to patient care, but they must also collect payment for their services.
According to a recent study performed by Change Healthcare, approximately 9 percent of hospital charges in 2016 were initially claim denials, resulting in a revenue loss of $262 billion from healthcare organizations nationwide.
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.
Two of the most important Key Performance Indicators (KPIs) used in determining the health of your revenue cycle are: Accounts Receivable (A/R) performance and claim denial percentage.
Here, we will help you tighten your internal claims processing system by outlining the most prominent causes fo insurance denials within the billing sphere.