Do you feel like your healthcare enterprise is playing a board game and rolling the dice when it comes to managing claim denials? You are not alone. The follow-up process has certainly changed and become a huge burden for providers.
Claim denial rates have increased more than 20% over the past five years, with average claim denial rates hitting 10% or more, according to the Journal of AHIMA.1 Revenue cycle leaders can spend as much as 30% of their time dealing with rising denial issues.
Payers Moving the Goal Posts
Why is this happening? Payers are constantly changing the rules, and it has become increasingly difficult to keep up with the volume of claims being denied. Payers are now leveraging artificial intelligence (AI) in order to delay payments and create more difficult paths for providers to resolve claims.
The data science allows payers to identify where a specific healthcare provider has weak spots in their process and take advantage of them. The Healthcare Financial Management Association (HFMA) reported in 2023 that payers are denying healthcare organizations as much as $262 billion annually. This translates on average to $5 million denied per provider.2
The Role of AI in Mitigating Claim Denials
The speed at which this is occurring makes it very difficult for healthcare organizations to pivot and respond. Only organizations that adopt AI automation have a chance to mitigate this new game played by payers.
Meduit can help level the playing field by deploying denials management solutions coupled with AI technology, SARA™, short for Supervised Autonomous Revenue Associate. Meduit’s modeling, automation and processes allow healthcare staff to resolve accounts receivable in a timely fashion and maintain a steady cash flow to finally win the claim denials game. Contact Meduit to learn more: contactus@meduitrcm.com.
1Claims Denials: A Step-by-Step Approach to Resolution (ahima.org). Accessed 1.25.24.
2https://www.hfma.org/revenue-cycle/denials-management/61778/. Accessed 1.29.24.
