Case Study
Ten Steps to Reduce Denials,Win More Appeals, and Improve Hospital Performance
Every day, someone at a health system or hospital asks me a variation on this question: How can I better manage denials? There’s tremendous pressure to reduce denials. According to CMS, 20% of all claims are denied, 60% of lost or denied claims will never be resubmitted, and 18% of claims will never be collected. 1 Reworking each claim costs around $25. 2 The problem is worsening as the complexity of claims processing intensifies. Our population is aging rapidly, care needs are increasing, Medicare enrollment is rising, comorbidities and chronic conditions are more prevalent, and population health management is also taking hold. Health systems are transitioning more patients across multiple settings and specialists, requiring multiple claims. No wonder CFOs, CNOs and CMOs are w
