FinancialHospitals

More than 30% of hospitals are near the “danger zone” of denial rates

The pandemic has only made the trend worse, as 33% of hospital executives report average claims denial rates of 10% or more.

June 18, 2021 / Jeff Lagasse, Associate Editor

Hospital claim denial rates have hit new highs, with a 20% increase in those rates over the past five years, suggesting that better claims denial management processes are necessary, finds a new survey from research firm Harmony Healthcare.

The ongoing COVID-19 pandemic has only made the trend worse, as 33% of hospital executives report average claims denial rates of 10% or more. Nationally, hospitals are facing average denials rates between 6 and 13%, which hospital leaders say is nearing the “danger zone.”

Broken down even further, 31% of hospital executives reported average denial rates of less than 5%; 20% reported rates of 5 to 7%; and 16% reported rates between 8 and 10%.

WHAT’S THE IMPACT

The public health emergency has diverted some attention away from this issue, but with the crisis beginning to pass, many hospitals and health systems are ready to recommit to lower denials, as it’s seen as a facet of achieving financial recovery.

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Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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