One of the Industry’s Largest Clearinghouses Provides Insight Based on 262 Million Claims Representing $810 Billion in Provider Revenue
Today RelayHealth Financial disclosed denial rate data for more than 262 million claims processed between October 1, 2015 and February 15, 2016. Of the $810 billion in claims processed using RelayHealth Financial revenue cycle management solutions, just 1.6% have been denied. This denial rate is expressed as a percentage of claim dollars that were initially denied for ICD-impacted denial categories in relation to dollars billed on remitted claims. This rate reflects only the denial categories of Authorization/Pre-Certification, Medical Coding, Medical Necessity, and Untimely Filing. This denial rate has remained unchanged since November and represents approximately $12.9 billion in denied claims since Oct. 1st.
“The good news is that we’re not seeing a marked increase in claim denial rates when it comes to ICD-10, and there is heightened interest in denial management and prevention,” said Marcy Tatsch, Vice President and General Manager, Reimbursement Solutions for RelayHealth Financial. “The bad news is that as many as 1 in 5 claims is still denied or delayed within the normal hospital and provider revenue cycle world, which can mean a dip of as much as 3% in a hospital or health system’s revenue stream2. While it’s important to keep monitoring those KPIs that are monitored on RelayHealth Financial’s Denials Dashboard, healthcare providers should now ramp up their broader denial prevention and management efforts.”
To help providers understand and navigate the challenges surrounding strategic denial prevention and management, RelayHealth Financial now offers an online resource: ReduceMyDenials.com. The site features a number of resources that focus on best practices and operational considerations, with links to case studies, white papers, and a webinar focused on helping providers reduce and manage denials.
Visit RelayHealth Financial at HIMSS16 in the McKesson booth #4002.
Source: http://www.businesswire.com/