Undeniable Challenges–The Reality of Healthcare Claims Denials

Denial management in healthcare continues to be a challenge for providers—in part because the traditional way of working denials is time-consuming, costly, and prone to error. ICD-10 sparked additional denial management-related worries in October of 2015, based on projections that denial rates might increase 100%-200%. Ultimately that didn’t occur (though the CMS grace period may have been an influencing factor)—but nonetheless, denials continue to eat up as much as 3-5% of provider revenue, and according to some projections denial rates for providers trend as high as 20%.

Like all RCM challenges, providers are seeking technological solutions—but until recently, denial management software did little if anything to effectively automate the manual and inefficient aspects of working and appealing denials.

Check out our infographic for more details on preventable denials, the average time it takes to work denials (as well as the most time-consuming aspects of denial management), and more detail on the reality of denials and why there continues to be a need for world-class denial management software in healthcare today!