Crowe report highlights financial challenges
healthcare providers are currently facing
CHICAGO, Feb. 15,
2023 /PRNewswire/ -- Healthcare systems have
found themselves in precarious financial standing due to a dramatic
increase in the number of inpatient claims being denied by health
insurers based on the lack of medical necessity, according to data
collected by Crowe LLP. Crowe is a public accounting, consulting
and technology firm in the U.S. with offices around the world. A
new benchmarking report, "Who's Picking Up the Check?," analyzes
information pulled by Crowe Revenue Cycle Analytics (RCA) software
and reveals the financial implications of these level-of-care
reimbursement disputes, which are particularly rising in frequency
among the Medicare Advantage (MA) payor group.
Crowe RCA software monitors every patient financial transaction
from more than 1,700 hospitals and 200,000 physicians for the
purposes of automating hindsight, providing accounts receivable
valuations and analyzing net revenue. Crowe leverages data gathered
from clients on the Crowe RCA platform to monitor payor behaviors
both within specific markets and nationally. Insights gleaned from
this data aim to arm providers with actionable insights to support
targeted performance discussions with their payors.
One of the most straightforward payor categories when it comes
to assigning the appropriate level of care is traditional Medicare.
MA plans, on the other hand, have adopted more restrictive
criteria commonly used by commercial health insurance carriers and,
according to the Crowe report, deny more inpatient hospital claims
than all other payor types. Through November of 2022, the initial
inpatient level-of-care claim denial rate for MA plans was 5.8%
compared with 3.7% for all other payor categories. When isolating
just the payors within the MA plan population, providers wrote off
8.5% of their inpatient revenue as uncollectible in comparison to
4.7% in 2021.
"In 2022 alone, clients in our benchmarking database wrote off
$535.4 million on account of Medicare
Advantage plan denials based on lack of medical necessity," said
Colleen Hall, managing principal of
the healthcare group at Crowe. "Given the immense popularity of
these plans, healthcare providers will have to adjust their
clinical operations and should ensure their revenue cycle and care
management teams are in alignment on which denied claims should be
prioritized when managing appeals."
The Crowe report also revealed:
- In 2021, providers wrote off 3.6% of their inpatient revenue as
uncollectible. Through November 2022,
that number jumped to 5.9% – a 64% increase.
- Through November 2022, the dollar
value of initial clinical denials by payors represented 4.2% of
billed inpatient dollars. That percentage is 18.5% higher than in
2021.
"One step that providers can take to try to prevent these
reimbursement issues is to implement a physician adviser program to
verify patient status and allow for peer-to-peer reviews to be
completed when payors offer them," said Hall. "This could help
alleviate the administrative burden placed on them to defend the
level of care, so hospitals can allocate more of their resources to
caring for their patients."
To download a copy of the latest Crowe RCA report, please visit
"Who's Picking Up the Check?"
About Crowe Revenue Cycle Analytics (Crowe RCA) benchmarking
data
Over 1,700 hospitals and more than 200,000 physicians use the Crowe
RCA solution to capture every patient transaction for purposes of
automating hindsight, providing accounts receivable valuations and
analyzing net revenue. Crowe developed this proprietary
benchmarking solution that monitors revenue cycle performance
through normalized key performance indicators at healthcare
organizations across 47 states and tracks over $800 billion in combined annual gross
revenue.
About Crowe
Crowe LLP is a public accounting, consulting and technology
firm with offices around the world. Crowe uses its deep industry
expertise to provide audit services to public and private entities.
The firm and its subsidiaries also help clients make smart
decisions that lead to lasting value with its tax, advisory and
consulting services, helping businesses uncover hidden
opportunities in the market – no matter what challenges the markets
present. Crowe is recognized by many organizations as one of the
best places to work in the U.S. As an independent member of Crowe
Global, one of the largest global accounting networks in the world,
Crowe serves clients worldwide. The network consists of more than
200 independent accounting and advisory services firms in more than
130 countries around the world.
Twitter: @CroweUSA
LinkedIn: Crowe
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SOURCE Crowe LLP