Monday, April 17, 2017

Avoiding Denied Claims is Crucial to Good Hospital Revenue Cycle Management

According to a report by Relay Health Financial, large hospitals in the Northern Plains have higher average claim denial rates compared to other areas in the country at a surprising 10.58%. The report defines large hospitals as facilities that host 250 to 400 beds. The percentage was derived by comparing the claims dollars that were denied relative to revenue successfully billed on the claim.

The South Central region, meanwhile, topped the list among mid-sized hospitals (100-250 beds), with a denial rate of 8.82%. The region also ranks second among large hospitals, registering a denial percentage of 8.8%.

Of course, as any healthcare executive knows, denial rates are simply part of business. After all, insurers closely scrutinize each claim to see if they should indeed pick up the tab for the patient. However, keeping denial rates to a minimum is a crucial part of hospital revenue cycle management. After all, when claims are denied, unpaid bills have a higher chance of becoming potential bad debt.

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