According to the AMA’s health insurer report card, denial rates of claims for major private payers ranged between 0.54% and 2.64%. At the same time, denial rates for Medicare stood at close to 5%. Although the percentage does not sound like too much, given the fact that billions of dollars are claimed each year, the figures for denied claims suddenly assumes gigantic proportions.
Claim submission and denial management are critical components to the revenue cycle of healthcare facilities. As regulations are getting more stringent with the transition to value-based care, healthcare providers are facing an increase in claim denials. It therefore comes as a surprise that nearly one-third of clinicians are still using manual processes to manage their claim denials.
The ever-changing healthcare scenario is making it difficult for clinicians to manage their finances. On one hand, the number of patients are increasing every day, while on the other, reimbursement by insurance companies for medical care provided is being reduced. Rising expenses and tons of paperwork; compliance issues and fears of a malpractice suit – all these are creating pressures on healthcare providers to maintain their standards of care and service.