DOTmed December 29, 2023
At a time of rising costs, labor shortages, and operating margins still below historical levels, many hospitals are simply not in a position to absorb any loss of revenue. Yet that’s exactly what is happening when it comes to managing the influx of denied claims as part of the revenue cycle management (RCM) workflow.
Hospitals are grappling with a surge in claims denials, marked by an increase in the average dollar value per denial, extended resolution times, and reduced yield per claim across all payer types. A Kaiser Family Foundation study on Affordable Care Act (ACA) health plans found that, on average, insurance companies initially deny 17% of claims, even for in-network care. Prior authorization denials have also risen, as...
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