RelayHealth Financial, one of the industry’s largest clearinghouses, recently disclosed denial-rate data for more than 262 million claims processed between Oct. 1, 2015, and February 15, 2016. Of the $810 billion in claims processed using RelayHealth Financial revenue cycle management solutions, just 1.6 percent have been denied.
This denial rate is expressed as a percentage of claim dollars that were initially denied for ICD-impacted denial categories in relation to dollars billed on remitted claims. This rate reflects only the denial categories of Authorization/Pre-Certification, Medical Coding, Medical Necessity, and Untimely Filing. This denial rate has remained unchanged since November and represents approximately $12.9 billion in denied claims since Oct. 1.
“The good news is that we’re not seeing a marked increase in claim denial rates when it comes to ICD-10, and there is heightened interest in denial management and prevention,” said Marcy Tatsch, Vice President and General Manager, Reimbursement Solutions for RelayHealth Financial, in a company statement. “The bad news is that as many as one in five claims is still denied or delayed within the normal hospital and provider revenue cycle world, which can mean a dip of as much as 3 percent in a hospital or health system’s revenue stream. While it’s important to keep monitoring those KPIs that are monitored on RelayHealth Financial’s Denials Dashboard, healthcare providers should now ramp up their broader denial prevention and management efforts.”
