Claims Appeals Cost Hospitals Up To $8.6B Annually

Claims Appeals Cost Hospitals Up to $8.6B Annually

  • June 26, 2017

Of an estimated $3 trillion in claims submitted by hospitals in 2016, nearly 9% of those charges were initially denied, HealthLeaders Media reports. Citing figures from the first-ever Healthy Hospital Revenue Cycle Index compiled by Change Healthcare, Senior Leadership Editor Philip Betbeze says that number translates to $262 billion in at-risk revenue for providers. Read the article

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Denial Rework Costs Providers Roughly $118 Per Claim: 4 Takeaways

Denial rework costs providers roughly $118 per claim: 4 takeaways

  • June 26, 2017

A new analysis from Change Healthcare estimates that $262 billion, or 9%, of the nearly $3 trillion in claims submitted by hospitals last year were initially denied, according to  Becker’s Hospital CFO Report. Becker's Kelly Gooch cites four key takeaways for providers from the Change Healthcare Healthy Hospital Revenue Cycle Index report. Read the article

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$262B Of Total Hospital Charges In 2016 Initially Claim Denials

$262B of Total Hospital Charges in 2016 Initially Claim Denials

  • June 26, 2017

Nearly 9% of hospital medical claims in 2016, representing some $262 billion, were initially denied, RevCycle Intelligence reports. Citing the Change Healthcare Healthy Hospital Revenue Cycle Index published today, editor Jacqueline Belliveau notes that up to 3.3% of net patient revenue at a typical health system was at risk because of claims denials. Read the article

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Report: $262B In Healthcare Claims Initially Denied Last Year

Report: $262B in healthcare claims initially denied last year

  • June 26, 2017

A new study found an estimated 9% of claims submitted to payers last year were initially denied, Healthcare DIVE says. Writer Les Masterson, reporting on the newly issued Change Healthcare Healthy Hospital Revenue Cycle Index, says that figure represents $262 billion of the $3 trillion in charges submitted, adding that as much as 3.3% of net patient revenue, an average of $4.9 million per hospital, was “put at risk due to denials.” Read the article

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Change Healthcare Analysis: $262 Billion In Healthcare Claims Initially Denied In 2016

Change Healthcare Analysis: $262 Billion in Healthcare Claims Initially Denied in 2016

  • June 26, 2017

A new study by Change Healthcare shows that of $3 trillion in medical claims submitted last year, $262 billion worth were initially denied. And while an average of 63% of those claims were recoverable, appeals-related administrative costs totaled $8.6 billion. The good news is that providers can now see where they might be falling short by studying the Healthy Hospital Revenue Cycle Index, and take the steps needed to cut their losses. Read the news release

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Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 8, 2017

The health care industry’s claims payment system is frustrating, inefficient, and prone to errors, according to a new Op-Ed in Morning Consult. But Amy Larsson says one way to overcome these challenges is to start automating disparate payment systems to reduce manual interventions and thus the errors they might introduce. Read the article

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Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 6, 2017

By Amy Larsson RN, BSN, MBA The U.S. healthcare industry’s claims-payment system is frustrating to providers, payers, and patients alike. Inefficiency and a systemwide tendency for error wastes precious resources, worsens miscommunication and mistrust among all stakeholders, and inhibits the ability to transition to value-based approaches that achieve better outcomes. We need to rethink our industry’s disjointed and siloed approach in order to solve a very integrated problem. Despite billions invested in achieving efficient claims payment, more than 7% of claims are not paid correctly the first time, the second time, and sometimes even the third time¹. The remediation process…

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Reinventing Utilization Management To Bring Value To The Point Of Care

Reinventing Utilization Management to Bring Value to the Point of Care

  • June 6, 2017

How an automated exception-based approach can make UM more efficient and effective By Nilo Mehrabian How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden? The shift from volume to value-based care requires the deft combination of value-based delivery (enabled through actionable intelligence and new care delivery models) and value-based payment (enabled through select provider networks and new reimbursement models). Providers and payers must operate across a transparent, administratively simple, shared ecosystem. This giant leap from today’s world in which healthcare stakeholders currently operate might…

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