Dealing with Denials: 90% of inpatient denials are preventable. So why do they keep happening? A compendium of research
Written for AppriseMD
The headlines continue to show the financial difficulties facing hospitals. Administrators are being forced to make difficult decisions amid sometimes overwhelming circumstances to earn profits or just break even. The challenges are many, including staff shortages, increased patient acuity, and longer average lengths of stay due to delayed care during the pandemic. On top of those staffing and patient issues, add a steady increase in inpatient denials from insurance companies and you have the perfect storm for a revenue cycle disaster. Some hospitals are reporting operating losses in the hundreds of millions of dollars, while others from Iowa to North Carolina are laying off hundreds of workers in order to increase revenue.
But the news is not all bad. There is a way to increase revenue that doesn’t rely on the pandemic ending or the economy improving. The way is to use proven strategies to reverse the trend of increasing denial rates. Ultimately hospitals and other healthcare providers can no longer ignore the impact inpatient denials can have on their cash flow. Ninety percent of all denials are preventable, so why aren’t more denials being prevented? If an organization takes a focused and unremitting approach to tackling this problem, it can see improvements in lowering denials and increasing overturned denials. This approach requires persistence and commitment to proper documentation, plus a clear utilization review strategy together with a team approach. The result will help support the financial health and future sustainability of the organization.
