Best Practices in Denial Management
Denials remain a significant challenge in healthcare revenue cycle management (RCM), creating disruptions that can compromise both financial...
Over the past 24 months, already-thin hospital margins were further exacerbated by COVID-19. Hospitals are seeing up to $50 million in revenue leakage per facility per year from underpayments from payers, poor claims management, denials, under and uninsured—all leading to uncompensated care, and ultimately, bad debt. Since 2016, health systems have faced a 23% uptick in claim denials rates, a 34% year over year decrease in operating margins and a 60% increase in prior authorization use.
Technology seems like the obvious answer to this dilemma, but traditional approaches haven’t worked. Revenue Cycle Management (RCM) technology attempted to stop the leaks, saturating the space with thousands of bolt-on solutions, but it only exacerbated the problem. Nearly 70% of hospitals are using multiple vendors to manage their revenue cycle, but many are seeing new problems emerge as precious time and dollars are spent on vendor coordination and alignment, rather than patient care.
Some of the key drivers of waste include:
- Invoice costs
- Data silos and inoperability
- No alignment to larger process
- Multiple files, returns and portals
- More denials
- More leaked revenue
- Higher cost of ownership
Patient expectations
As the digital transformation in healthcare continues to take hold, patients expect a modern financial experience: 79% want upfront estimates of healthcare costs and 56% desire digital payment options. Price transparency requirements and consumer expectations put added pressure on providers to deliver a better patient experience alongside high-quality care. These growing pressures require a shift away from the current paradigm.
Revenue management reimagined
We must rethink revenue management and break the cycle of inefficiency with a new way forward: a single-vendor solution that empowers healthcare organizations to transform the patient financial experience and accelerate financial recovery.
At FinThrive, we’re transforming healthcare revenue. We’re delivering the industry’s most comprehensive end-to-end revenue management platform, designed by revenue professionals for revenue professionals. It brings a deeply integrated and complete set of market-leading revenue management solutions to RCM staff and a 360-degree view of financial performance across all stages to the C-Suite. Together, these solutions improve clean claim rates, increase net operating margins, reduce A/R days and help healthcare systems stay ahead of regulatory mandates.
Learn more about automated, end-to-end revenue management that connects our industry.
