Claims Denial is #1 Revenue Cycle Pain Point

Joyce Szymanski

Is claims denial your #1 headache in revenue cycle management? If so, you’ve got plenty of company.

In a recent online survey of Centricity™ Business customers conducted by GE Healthcare, nearly 70% listed denials management as their top revenue cycle process challenge. It was the biggest pain point by far among revenue cycle decision makers and influencers at medical centers and practice groups.

Referrals and Authorizations was the next most vexing challenge, listed by 41% of those surveyed.

Insurance Follow-Up was close behind, cited by 37%.

These also made the list of leading issues:

  • Self-pay
  • Payer contracts
  • Charge editing
  • Charge capture

Much less troubling but still causing pain:

  • Claims submission
  • Electronic payment remittance
  • EDI processes

The survey also found that to reduce claims denials, customers are turning to analytics. 63% surveyed identified analytics as the way to improve denials.

Additional priorities for optimizing the revenue cycle:

  • Further automating key claims workflows and A/R follow-up
  • Analyzing profitability and effectiveness of payer contracts
  • Assessing and improving general revenue performance, leakage and profitability

These areas were seen as less pressing but still needing attention:

  • Automation of processing and posting of payments
  • Automation/implementation/management of bundled payments

What are you doing to reduce claims denials? Are analytics part of your approach? Do your top revenue cycle challenges match the survey?  Post a reply to let us know.


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