HealthIT Answers December 6, 2023
Facing both revenue and expense issues and exasperated by clinician shortages, hospitals are increasingly noting denials in the danger zone. “Danger zone” translation: Denials are increasingly higher than 10%, costing significant dollars in lost or delayed reimbursements – as well as more overhead for rework and resubmitting claims. A recent Crowe RCA benchmarking analysis provided the industry-wide numbers: Claims denials rose to 11% of all claims last year, up nearly 8% from 2021.
Winning with denials means focusing on both administrative and clinical denials. On average, clinical denials account for 45-50% of the total denials. Not included in this number are payer post-pay audit payment takebacks. Payers get a second chance at these denials, often two and three years post...
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