Cracking the Denials Code:
Enhance Healthcare Financial Performance

Healthcare finance leaders serve as a cornerstone within their organizations and they are equipped to identify what’s working well, invest in technology and set goals to improve financial performance across the revenue cycle.

According to FinThrive’s 2024 RCM Transformative Trends Report, which surveyed 92 healthcare finance executives, 70% said increasing revenue was their top goal this year.

But what strategies need to be implemented to capture every dollar?

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Healthcare leaders say it starts with denials.

76%

said reducing denials was the top planned initiative

67%

indicated the need to improve the prior authorization process – a common source of denials

36%

stated improving the patient payment experience was a factor

Now, let’s look at the “why” behind the denials conundrum in healthcare.

With every passing year, denials seemingly become a bigger thorn in the sides of providers and patients.

The reason? Payers are playing hardball.

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The burden is only getting heavier for hospitals and health systems

97%

report patients experienced delays or denials for medically necessary care due to prior authorization requirements1

95%

report increases in staff time seeking prior authorization approval2

84%

say the cost of complying with insurer policies is increasing3

78%

indicated that their experience with commercial insurers is getting worse4

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Denials also impact healthcare organizations’ bottom lines

$1.6M

in denial write-off adjustments
(mid-sized $350M NPR hospital)5

7-11%

of claims are underpaid6

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Denial write-offs are only getting worse

4X

Since 2018, denials have increased four times7

<1% NPR

Industry best practice benchmark

4.6% NPR

Current average write-off percentage

So what can providers do to bend the denials curve?

Here are six ways to address some of the most common denials.

Inaccurate or Insufficient Documentation

Problem:Incomplete patient information, missing signatures and illegible paperwork can lead to claim rejection

Solution:Verify information during pre-service withdigital registration and patient scheduling solutions

Prior Authorizations

Problem:Disconnection or miscommunication between providers and payers makes it difficult to obtain necessary authorization prior to care

Solution:Streamline authorization processes with electronic, real-time solutions that facilitate better communication with payers

Coding Errors

Problem: Mismatched diagnosis and procedure codes or incorrect modifiers

Solution: Invest in coding education and training for staff, conduct regular audits and compliance checks to identify and fix coding errors quickly

Timely Filing Limit Exceeded

Problem: Failure to meet payer deadlines of when claims must be submitted

Solution: Utilize sophisticated claims technology to ensure timely claim submissions

Insurance Coverage Issues

Problem: Expired policies or services not covered under a patient’s plan

Solution: Verify insurance coverage and eligibility prior to billing with an insurance discovery solution

Ready to tackle claim denials head-on?

Contact us to discover expert strategies and solutions to boost revenue and enhance patient satisfaction.