10 Key Facts Hospitals Should Know About Denials in 2021

Aside from the number one goal of providing quality patient care, hospital and health system executives will tell you that driving revenue is key. Keeping the doors open and lights on – especially in today’s tumultuous post-pandemic business climate, has become more challenging than ever. Organizations are constantly seeking ways to generate revenue and sustain profit margins by reducing expenses and optimizing processes without impacting care delivery.

One area that’s always ripe for improvement is denials management. According to a recent survey, the average rate of denied claims across U.S. hospitals and health systems ranges between six and 13 percent. More than one-third of hospital reimbursement executives reported that their organizations are nearing the denials danger zone of ten percent.

Preventing denials, managing audits and winning appeals is not easy, especially when teams are stretched thin. Staff cuts and employee turnover in a tough labor market as a result of COVID-19 have impacted most hospitals and made this tough situation even worse.

So what can be done to help organizations do more with less? For starters, a proactive approach can go a long way in heading off denials before they hit the books. It’s definitely easier said than done, but not impossible. Education is key – especially when it comes to training new or less experienced employees and making sure they understand why denials happen and how they can be avoided.

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