It has been reported that denied claims represent 90% of missed revenue opportunities. Whether this is true or not, we all can believe that denied claims are a burden due to rework and chasing for dollars that have already been spent!
According to Change Healthcare, it costs an average of $6.50 to file an initial claim. If denied, that one claim can cost an additional $25.00 to resubmit. And we know, often it takes more than this! So say you have 100 denied claims per month – the cost of submission is around $30,000/year. Now, if a larger organization gets 1000/mo or even 1000/week in denied claims, you can see how quickly the expense adds up to resubmit denied claims.
According to a study conducted by CMS< 60% of denied, lost or ignored claims will never be paid in full. What changes are you putting in place to decrease first pass denials? We know that determining benefit eligibility/verification, getting medical necessity documentation prior to and during care delivery can help make this happen. Many organizations have addressed the low hanging fruit and improved these processes. However, begin looking below the surface for many of those difficult areas that create claim denials, such as changes in procedures from that which is scheduled, or same day authorizations that are needed for radiological services. Design workflows and processes to avoid denied claims and rework among your team members.