Lexology July 22, 2024
Healthcare operators face growing denial rates and longer reimbursement timelines. AI can help, but it’s just one facet of revenue cycle management, and can’t be implemented without an understanding of the end-to-end processes.
Healthcare operators are facing a cash crunch. Insurance denials typically range from 10% to 20% of claims, according to a ProPublica investigation, though KFF has found Medicaid claim denials go as high as 49%, and advanced claims review systems have contributed to the issue. Several large insurers are facing litigation over their use of AI and advanced technology to review (and deny) claims, and legislators are looking at how to regulate that technology. For now, that means there’s an increasing probability that providers have done the work...
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