Claims denials have increased between 10%-15% according to a recent Experian Health survey of over 200 heath leaders. This growing number has pushed denials management to the forefront of hospital priorities, as 78% of respondents note their organizations are likely to replace their existing claims management solution to help deliver greater return on investment (ROI).1
When asked why claims denials have taken precedence over other hospital issues, the survey noted four key reasons:1
- Payer policy changes occurring more frequently (67%)
- Reimbursement taking longer (51%)
- Increase in claim submission errors (43%)
- Overall increase in denials (42%)
A lack of expertise in handling the overall claims denials process is a major contributor to the ongoing rise in denials – ultimately leading to operational challenges and costly rates across the care continuum.
To supplement this lack of expertise, hospitals have begun implementing technology solutions. However, technology is only a stopgap to the ongoing problem. Having the right expertise on hand can play a pivotal role in a hospital’s ability to overcome current and future claims denials challenges. One way hospitals are accessing this expertise in through partnership.
Opportunities for reducing denials and improving hospital efficiency
The revenue cycle system utilized by American health care is among the most complex and challenging to navigate. Building and managing an effective denials management system in-house can be difficult.
Forty-three percent of respondents plan to leverage outside expertise from a trusted expert to meet the needs of their hospital, according to the survey.1 This number is expected to rise as merger and acquisition (M&A) and joint venture partnerships have experienced rapid expansion in recent years.2
The right partner will have access to specialized staff trained in navigating the intricacies of the claims denials space in addition to the overall regulatory environment. They will also have clinical liaisons that help effectively identify patients that qualify for various specialized services – getting patients to the right care setting, in the right time in their care journey.
Having an experienced partner can help hospitals regain control of their denials process without having to spread their existing resources too thin and can therefore remain focused on their core service lines and most importantly, patient outcomes.
Contact us today to learn how partnership with Lifepoint can help your hospital overcome today’s denials challenges and prepare for future shifts.
References:
- Experian Health. (2022). The State of Claims – 2022 report. Experian Health. Retrieved January 25, 2023, from https://www.experian.com/healthcare/resources-insights/thought-leadership/white-papers-insights/state-claims-report
- Liss, S. (2023, January 18). After uptick last year, hospital M&A likely to continue to rise in 2023. Healthcare Dive. Retrieved January 25, 2023, from https://www.healthcaredive.com/news/hospital-mergers-acquisitions-rebounded-last-year-expect/640518/
