Building an Effective Denial Prevention Team to Mitigate Revenue Loss

MedCity News August 28, 2024
Rhonda Kamenick

Sluggish margins and high costs have created a challenging environment for provider organizations. With the number of denied claims increasing significantly over the past few years, so has the time and resources needed to manage those denials.

Providers spend more than $10 billion annually reviewing and managing denials for claims that should have been paid upon first submission. Medicare Advantage (MA) plans are particularly problematic as more than half of their denials are eventually overturned, meaning they should have been paid initially. The time and money spent to research and appeal these claims cause providers to lose out on much-needed revenue, especially since they often don’t have time to appeal every denial.

According to a recent survey, the average cost...

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