Case Study
The Denials Challenge: An Analytics-Driven Approach to Denial Prevention and Management
Healthcare providers are chiefly concerned with two things: ensuring patients receive the highest quality of care, and getting paid for that care. Despite advances in medical technology and a declining number of uninsured Americans, hospitals still have trouble getting paid fully and in a timely manner. Hospital and health system CEOs have named financial challenges as their number one concern every year since 2003 according to the American College of Healthcare Executives. 2 Denials are a pervasive and persistent problem, with one in five claims delayed or denied. 3 This represents a significant financial drain, ultimately costing a typical health system as much as 3.3% of net patient revenue, or an average of $4.9 million per hospital, put at risk due to denials. 4 There is no