Managing claim denials is essential in the revenue cycle, recouping lost healthcare revenues and maximizing reimbursements. So what if you could stop (or at least reduce) claim denials in their tracks?
According to a recent article from RevCycle Intelligence, “About 9% of hospital charges in 2016 were initially claim denials, putting about 3.3% of net patient revenue at risk, per hospital.” Even more startling, Medical Group Management Association (MGMA) found approximately 65% of denied claims were never corrected and re-submitted to payers. Knowing how to prevent denials is crucial to the financial success of a healthcare organization.
Claims can be denied by insurance companies for a multitude of reasons, most common being:
- 14.6% missing or invalid claim data
- 12.4% authorization and pre-certification issues
- 10.8% medical documentation requested
- 10.1% service not covered
Problems with authorization and pre-certification are largely responsible for the reported increases in claims requirements. As third party payers work to decrease expenditures, healthcare professionals are taking notice. A recent Medical Group Management Association (MGMA) poll uncovered that “86% of medical practice leaders witnessed an increase in prior authorization requirements over the past year.” Denials caused by authorizations and pre-certification are, for the most part, preventable, but may be a burden to your business office.
“Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers and patients because processes vary and can be repetitive,” according to America’s Health Insurance Plans. Streamlining prior-authorizations through a third-party vendor with a team of experts and advanced technology removes the burden of prior authorizations from the hospital business office.
HRG’s authorization team provides daily and monthly reporting on payer denials, identifies authorizations not needed, and recognizes scheduling issues. HRG also offers in-house consulting services to keep your authorizations at home by implementing new prior authorization strategies as well as training physicians and staff.
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