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Health Populi December 18, 2024
Using AI to Improve Claim Denials Management
HealthIT Answers September 26, 2024
By Sarah Mendiola, Vice President of Denials, R1
Claims denials are an issue that do not merely take a financial toll on healthcare providers; they create a ripple effect that delays payment, eats up staff time and resources, and worsens the patient experience.
Of course, the financial expense cannot be ignored. Hospitals and health systems spend an estimated $19.7 billion per year to fight denied claims, according to a recent report from Premier. The report revealed that 15% of all claims submitted to private payers for reimbursement are initially denied.
Among claims that were initially denied, 54% were ultimately overturned and paid, but only after multiple, costly rounds of provider appeals. The average cost of fighting a claim stood at...
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