Transforming Denials Management: Insights and Best Practices for Your Organization

MedCity News April 22, 2024
Sunil Konda

Focusing on these areas can help healthcare organizations reduce the incidence of denials, optimize revenue cycle performance and enhance overall patient satisfaction.

Denied claims are becoming a financial nightmare for healthcare organizations, with costs skyrocketing.

Effective denial prevention and management have never been more critical, especially considering:

• Medicare Advantage denials increased by 56%, and commercial denials jumped by 20% in 2023.
• 12% of all claims are denied upon initial submission, and of those denials, 31% are absolutely avoidable, 51% are situationally avoidable, and 43% cannot be recovered.

These high percentages underscore a significant opportunity for organizations to mitigate financial pressures amidst uncertain economic conditions and improve operational efficiency by implementing robust denial prevention strategies.

Denials impact...

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