65% of Denied Claims Never Resubmitted to Payers, Causing Provider Revenue Loss

11.14.2017
Denied claims are so commonplace in medical practices, nearly 65 percent of them are never reworked by providers. That’s just tossing away money that the practice has already earned for treatments and consultations staff have already provided. A full 50-65 percent of denied claims are never reworked and resubmitted, according to the Healthcare Business Management Association.

Denials are extremely common—the Employee Benefits Security Administration reports 200 million claims are denied every year in the U.S.—and take a considerable amount of time and money to resolve. Five to 10 percent of a practice’s claims are denied, according to the American Academy of Family Physicians (AAFP).

Investing in a denials identification and automated appeals process—recommended by the AAFP—eliminates the need to inspect each denial individually. The process should use existing payer rules to ensure you understand the reasons behind denials and identify common errors found in submissions. Having this information up-front ensures the same mistakes aren’t made again in the future.

Denials Management Solution can Lower Lost Revenue

It’s a given that some claims will be denied by payers for simple or complex reasons. Reworking those claims can be simple or complex, as well. Every claim that must be reworked costs the practice $25, according to MGMA, it’s critical to work with a partner that can provide a cost-effective strategy to deal with the issue.
The most effective services use two methods to recover denied claims:
  1. Use payer’s required template to automatically generate an appeal letter, which is then sent to payers for consideration.
  2. Look at current and retroactive denials to ensure the practice receives all the reimbursement it deserves.
Both can help lower the number of claims written off each year by physicians.

Attempting to appeal denied claims without the right tools is difficult and time-consuming. An automated process reduces the amount of time needed to spend on the task, which improves overall practice efficiency and productivity and, importantly, helps ensure the practice receives payment for service it’s already provided.
 
If you’d like to find out how TriZetto Provider Solutions can help your practice perform better, please contact us at providersales@cognizant.com or 1.800.969.3666.
 

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