Key Strategies to Reduce Denials
For most health systems, insurance claim denials are a significant financial liability. CMS denies nearly 26 percent of all claims, and 40 percent of those are never resubmitted even though two-thirds are recoverable and 90 percent are preventable.1 Usually health systems lose tens of millions of dollars struggling to reduce denials and the inability to identify and correct the root causes. Any large healthcare organization’s revenue cycle has a lot of variation and complexity. Policies and procedures differ from payer to payer, technology and communication systems vary from patient to patient, and the complexities of separate hospital and professional revenue cycles in the same system can lead to defects and waste. Most health systems have a vision of leading the county, metropolis, state or nation in healing, caring and discovering.…