New Study Reveals Impact Of Claim Denials On Providers

New Study Reveals Impact of Claim Denials on Providers

  • June 26, 2017

Medical claim denials--they erode providers’ bottom lines, impede timely reimbursement, and sap time and money to appeal. But how much hospital revenue is put at risk by denials annually? How much does it really cost to re-work a claim? What are provider organizations spending on appeals? How do denial rates compared across the country? These are some of the questions that Change Healthcare analytics experts looked to answer. And using our revenue cycle analytics tools—the same tools we provide to customers—we revealed the state of denials nationally. The answers, available in a new e-book, may surprise you. Download the e-book

Read More
Change Healthcare Analysis: $262 Billion In Healthcare Claims Initially Denied In 2016

Change Healthcare Analysis: $262 Billion in Healthcare Claims Initially Denied in 2016

  • June 26, 2017

A new study by Change Healthcare shows that of $3 trillion in medical claims submitted last year, $262 billion worth were initially denied. And while an average of 63% of those claims were recoverable, appeals-related administrative costs totaled $8.6 billion. The good news is that providers can now see where they might be falling short by studying the Healthy Hospital Revenue Cycle Index, and take the steps needed to cut their losses. Read the news release

Read More
The Perfect Pairing: Patient Access And Analytics

The perfect pairing: Patient access and analytics

  • March 28, 2017

While more providers are taking advantage of technology to improve front-end revenue cycle processes, analytics lags behind. But when applied to patient access, analytics can help identify issues with registration and eligibility accuracy, and reduce downstream denials. A recent article in Multibriefs outlines the benefits of using analytics to improve patient-access processes in a value-based world. Read the Article

Read More
Rethinking Denials Management

Rethinking Denials Management

  • March 16, 2017

Most organizations take an administrative approach to managing denials. Maybe that’s why they’re not collecting as much as they should. The Denials Challenge Few hospitals would admit to not having a denials management program, and yet as many as one in five claims for services already rendered are denied or delayed.1 Denials erode the provider organization’s bottom line, resulting in the permanent loss of an estimated 3% of net revenue.2 However, it’s not just the cost of the denials themselves, or the revenue lost–3% of the bottom line is significant no matter how it is sliced–it costs an average of…

Read More
Reinventing Claims Management For The Value-Based Era

Reinventing Claims Management for the Value-Based Era

  • February 17, 2017

Provider claims management as we once knew it is not enough to thrive in a value-based era. Here’s what you need to know about taking claims management to a higher level. By Carmen Deguzman Sessoms Provider claims management can no longer exist as a silo. With the rapid transformation from fee-for-service to value-based models, denial rates remain high–nearly 1 in 5 claims–despite advances in technology and automation.1 The complexity of value-based payment models almost guarantees an increase in denials, simply because there’s so much to get wrong. For provider CFOs and their organizations to be effective–and thrive–in this environment, the…

Read More
Authorization Playing Catch Up With Technology

Authorization Playing Catch Up With Technology

  • September 1, 2016

For as much as healthcare has been transformed by technology, there are still areas where it seems to be a game of catch up—such as obtaining pre-service authorization. While patients are becoming more involved in their own care, providers are increasingly incentivized to secure authorization from payers before procedures are performed to increase their likelihood of receiving payment. According to a June 2016 survey by HealthLeaders Media, pre-authorization is a consistent pain point that impacts leaders from the C-suite to operations and billing. A total of 158 surveys were completed by the Media Council, which consists of senior, clinical, operations,…

Read More
Ten Steps To Reduce Denials, Win More  Appeals, And Improve Hospital Performance

Ten Steps to Reduce Denials, Win More Appeals, and Improve Hospital Performance

  • June 24, 2016

By Tammie Phillips, R.N. Every day, someone at a health system or hospital asks me a variation on this question: How can I better manage denials? There’s tremendous pressure to reduce denials. According to CMS, 20% of all claims are denied, 60% of lost or denied claims will never be resubmitted, and 18% of claims will never be collected.1 Reworking each claim costs around $25.2 The problem is worsening as the complexity of claims processing intensifies. Our population is aging rapidly, and care needs are increasing. Medicare enrollment is rising. Comorbidities and chronic conditions are more prevalent. And population health…

Read More
Getting In Front Of The Problem: How Can Hospitals Empower Denial Prevention And Management?

Getting in Front of the Problem: How Can Hospitals Empower Denial Prevention and Management?

  • November 22, 2015

Healthcare providers are chiefly concerned with two things: Ensuring patients receive the highest quality of care, and getting paid for that care. Despite advances in medical technology and a declining number of uninsured Americans, hospitals still experience difficulty getting paid fully and in a timely manner today. Hospital and health system CEOs have named financial challenges as their No. 1 concern every year from 2012 to 2014, according to the American College of Healthcare Executives.1 Claim denials are a significant contributor to these challenges. Denials are a pervasive and persistent problem, as up to 1 in 5 claims is delayed or…

Read More