33% of Hospital Executives Say Their Average Denial Rates are More Than 10%

The average national denials rate is between 6% and 13%, but many organizations are nearing the denials "danger zone" of 10% of higher.

The denials rate has been steadily increasing over the past few years, and for one-third of hospitals, their average denials rate is more than 10%.

Harmony Healthcare surveyed more than 130 hospital reimbursement executives about the state of denials in their organizations.  

The average national denials rate is between 6% and 13%, but many organizations are nearing what Harmony Healthcare calls the denials "danger zone" of 10% of higher. The pandemic only exacerbated the issue of growing denials, they said.

"The public health emergency understandably diverted attention away from addressing this critical business issue," Randy Verdino, CEO of Harmony Healthcare, said in a statement.

According to the survey:

• 33% of hospital executives reported average denial rates of more than 10%
   
• 31% of hospital executives reported average denial rates of less than 5%
   
• 20% of hospital executives reported average denial rates of 5% - 7%
   
• 16% of hospital executives reported average denial rates of 8% - 10%

When asked about their top concerns regarding denials, several themes emerged:

• 32% of respondents reported their top concern as coding
   
• 30% of respondents reported their top concern as medical necessity acute IP
   
• 20% of respondents reported their top concern as the front end
   
• 18% of respondents reported their top concern as clinical validation denials