Rejections & Denial Management

A recent survey from Harmony Healthcare reveals that the healthcare industry has seen a 20 percent increase in claim denial rates in the past five years. The survey of 131 hospitals revealed that 33 percent of hospital executives reported average claims denial rates of 10 percent or more, a figure that indicates hospitals are nearing a “denials danger zone.

A transparency data released in 2020 by the Centers for Medicare and Medicaid Services (CMS) to examine claims denials and appeals among issuers from plan years 2018 and 2019 also reports about 17% of in-network claim denials in 2019, and about 14% of denials by issuers in 2018, with rates for specific issuers varying significantly around these averages. These findings make us believe that hospital claim denial rates are reaching an all-time high, signaling a need for better claims denial management.