"How to Avoid Costly Claim Denials and Improve Revenue Cycle Management"

Getting it right the first time is beneficial to all parties 

Claim denials can be quite costly and cause revenue leakage. In fact, Change Healthcare found that each denied claim costs about $118, contributing to about $8.6 billion in appeals-related administrative costs. The average claim denial rate typically falls between 6 and 13%. Healthcare providers consider a rate above 10% the “denials danger zone.” Change Healthcare found a claims denial rate of 11.1% upon the first submission through the third quarter of 2020.  Definitive Healthcare data shows 3.9% denial of Medicare inpatient claims and 1.8% denial of Medicare outpatient claims.  Change Healthcare found that 86% of denials are potentially avoidable. It also found that providers do not resubmit 65% of denied claims. So, if most denied claims are avoidable, why are claims denials on the rise? Let’s explore three reasons: 

1. Increased workload and shortage of staff  

2. New documentation

3. Backlogs of procedures and claims denials 

If your denials are not being worked consistently and completely, your AR is likely aging out. If you have claims older than 120 days, the chance of recovery is reduced significantly or even lost altogether. 

We offer a complimentary consultation to help identify where your AR is and help prioritize what YOUR clinic needs and where to start first.