Final Denial Rate for Inpatient Claims in 2023 Was More Than 50 Percent Above the Same Rate in 2021, According to Kodiak Solutions Data
May 21 2024 - 11:00AM
Business Wire
Increases in initial denials for prior
authorization/precertification driving up final denial rate for
inpatient claims, per Kodiak’s Revenue Cycle Analytics data
Hospitals and health systems are seeing a sharp increase in the
dollar value of claims that insurers are refusing to pay even after
appeals, according to data collected by Kodiak Solutions (formerly
Crowe healthcare consulting) and analyzed in its latest quarterly
revenue cycle benchmarking report.
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The final denial rate on inpatient
claims, as measured by the total value of denied claims as a
percentage of the total dollar value of inpatient claims tracked by
Kodiak Solutions' Revenue Cycle Analytics, increased by more than
50% from 2021 to 2023. (Photo: Business Wire)
The final denial rate on inpatient claims, as measured by the
dollar value of claims denied as a percentage of the total dollar
value of inpatient claims analyzed in the report, increased by 51%
from 2021 to 2023. That is according to analysis done using Revenue
Cycle Analytics, Kodiak’s proprietary software that monitors every
patient financial transaction from more than 1,850 hospitals and
250,000 physicians nationwide.
The increase in initial denials of inpatient claims by insurers
for prior authorization and precertification errors mirrors the
increase in the final inpatient denial rate: Initial denials for
these errors has risen from 1.73% of the value of inpatient claims
in 2021 to 2.18% in 2023, a 26% increase. Prior authorization and
precertification initial denials also are up for outpatient
procedures, from 0.93% of claims value in 2021 to 1.08% in 2023, a
16% increase.
“The increase in final inpatient claim denials drained $1.2
billion in revenue that hospitals and health systems rely on to
provide care to their communities,” said Colleen Hall, senior vice
president and Revenue Cycle leader at Kodiak Solutions. “On top of
that, more initial claims denials mean hospitals are spending more
money and other resources to appeal these denials, adding to the
financial impact of the revenue loss from final denials.”
Hall recommends revenue cycle leaders work closely with clinical
teams to align on the level of care provided to each patient,
analyze the differences in prior authorization and precertification
initial denials by payor, and communicate trends in payor behavior
with their advocacy partners, such as state and national hospital
associations and medical societies.
The May 2024 Kodiak RCA Benchmarking Analysis details the
differences in prior authorization and precertification initial
denials by payor type and provides additional insights on these
issues.
To view the full report, please visit “Necessity is the mother
of claim denials.”
About Kodiak Solutions Kodiak Solutions is a leading
technology and tech-enabled services company that simplifies
complex business problems for healthcare provider organizations.
For nearly two decades as a part of Crowe LLP, Kodiak created and
developed our proprietary net revenue reporting solution, Revenue
Cycle Analytics. Kodiak also provides a broad suite of software and
services in support of CFOs looking for solutions in financial
reporting, revenue cycle, risk and compliance, and unclaimed
property. Kodiak’s 400 employees engage with more than 1,850
hospitals and 250,000 practice-based physicians, across all 50
states, and serve as the unclaimed property outsourcing provider of
choice for more than 2,000 companies. To learn more, visit our
website.
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For Media: Vince Galloro (312) 625-2137
vince.galloro@sunrisehlth.com