Claims accepted on the first pass reduce a provider’s processing costs, shorten time-to-payment, and lead to more reliable forecasts.
The number one revenue cycle concern for providers is claims denials, and, they are concerned for good reason. Nearly one-third of hospital executives report average claim denial rates at 10% or more, a figure that has risen by 23% over the past five years and has been compounded by the global pandemic.
According to the HFMA, providers face an average of $5 million in denials annually. Those with a higher than average claim denials rate bear a greater proportion of that shortfall. In addition, hospitals and health systems are experiencing some of the worst margins since the beginning of the COVID-19 pandemic, putting 2022 on track to become the worst financial year for the healthcare sector since the crisis first started.
The good news for any provider achieving a less than optimal clean claim rate (CCR), there is a cost-effective path to improvement. Healthcare leaders who use automation within the revenue cycle reported having an average cost-to-collect of 3.51% compared to 3.74% for those who don't leverage automation. That .25% difference could potentially save hospitals and health systems millions of dollars. And by leveraging automation, healthcare organizations could help increase accuracy and efficiency and reduce initial denials. Maximize your staff productivity and be empowered to go beyond revenue cycle management into revenue cycle optimization!
A 95% clean claims ratio can be achievable, even in this challenging healthcare landscape. With the right billing practices in place and by optimizing your billing processes with the clean claims rate tips discussed in our E-book, you can maximize clean claims and minimize delays and denials - enhancing your revenue cycle management and profitability.
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