A 15% initial denial rate for commercial inpatient and outpatient claims is already enough to make denial management a finance problem, not a billing cleanup exercise. An analysis of more than 1,800 hospitals and 200,000 physicians found
A 15% initial denial rate for commercial inpatient and outpatient claims is already enough to make denial management a finance problem, not a billing cleanup exercise. An analysis of more than 1,800 hospitals and 200,000 physicians found
A denial rate of 20% across all claims was reported for insurers offering qualified health plans on HealthCare.gov in 2024, with 19% of in-network claims and 37% of out-of-network claims denied. KFF's analysis of 2024 claims denials
A patient arrives for a scheduled procedure at a hospital they deliberately chose because it's in network. The surgeon is in network. The facility is in network. Later, the anesthesia claim is processed as out of network,
The American Hospital Association reported that Medicare and Medicaid underpayments totaled $100.4 billion in 2020, up from $75.8 billion in 2019. Medicare payments covered only 84 cents per dollar of hospital cost, while Medicaid covered 88 cents,
In 2024, the average initial medical claim denial rate reached 11.8% across U.S. payer types, up from 10.2% in 2020, while roughly $262 billion in medical claims are initially denied each year. The problem is operational as
In 2024, more than 1.46 million federal No Surprises Act IDR disputes were initiated, while certified IDR entities closed more than 1.37 million. That was about 4.5 times the disputes closed in 2023 and more than 25
