Private Payers Retain Profits by Denying, Delaying Claims: What Rev Cycle Leaders Can Do About It

HealthLeaders Media March 22, 2024
Jasmyne Ray

While health systems are doing their best to maintain financial stability, payers are doing their best to protect their profitability.

A new report from Premier Inc found a trend in private payers denying claims, including prior authorizations. Out of all claims submitted to private payers for reimbursement, 15% were initially denied when submitted. Most of these claims were for higher-cost treatments.

Over half of the claims denied by private payers were approved and paid, but only after multiple rounds of appeals, according to the report. The average cost for providers fighting a denial was $43.84.

What Can Providers Do?

Payer struggles are a consistent issue for revenue cycle operations, being time consuming and costly, but revenue cycle leaders can push...

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