Reducing Denials Tops the List of Priorities for Revenue Cycle Leaders

Claims denials are increasing between 10%-15% according to a recently released survey.

According to a recently released survey conducted by Experian Health, the top three reasons for an increase in claims denials were insufficient data analytics (62%), lack of automation in claims/denials process (61%), and lack of thorough training (46%).

These results came from surveying 200 healthcare professionals, primarily in executive or management positions, who actively take part in the decision-making processes for their organizations' claims management systems.

Additionally, nearly three out of four respondents reported that reducing denials is their highest priority, and 70% said that it is more important than prior to the pandemic.

The reasons indicated for this higher priority include payer policy changes occurring more frequently (67%), reimbursement taking longer (51%), errors on claim submissions increasing (43%), and denials increasing (42%). Those who reported denials increasing pointed to operational challenges such as insufficient data and analytics to identify submission issues, lack of automation in claim submission/denials prevention process, lack of staff training, and lack of in-house expertise, among others.

“[The increase in denials] represents billions of dollars that will take longer than anticipated to be reimbursed—if reimbursed at all—which puts pressure on providers’ cash flow,” the study authors wrote. “The overhead to rework and resubmit these claims can be considerable and further dilute reimbursement totals.”

Almost all respondents indicated they had technology in place to help improve claims and reduce denials, with more than half (52%) having updated or replaced their existing claims process technology, 45% saying they automated tracking of payer policy changes. Providers also invested in patient portals (44%), accurate estimates (40%), and digitizing the registration process (39%).