In Healthcare, Time is Money | OIG | Appeals and Denials

Unlike other industries around the world, healthcare providers usually wait to receive payment for services provided. Even though a service may have been performed at the first of the month, it typically takes until the end of the month for that money to hit accounts receivable, and that is assuming everything goes right the first time.

 

In healthcare, time is money. It is important for providers’ claims to process cleanly, which will keep denials at a minimum. Thorough and accurate coding with supporting documentation ensures that the claims are approved and paid the first time.

According to the American Academy of Family Physicians (AAFP) the average national denial rate is between 5% and 10%. The lower the denial rate, the healthier the cash flow. Last year, the Office of Inspector General (OIG) performed an investigation that found, “between 2014 and 2016, Medicare Advantage organizations overturned 75% of their preauthorization and payment denials upon appeal,” which is why, at HIA, we always advise our clients to engage in the appeals process.

Partner with HIA to help reduce your denial rate below the industry average, so you can keep more money in your pocket rather than tied up in the denials process. LEARN MORE

 

 

Resources
aafp.org/practice-management/administration/finances/denial-rate.html
beckershospitalreview.com/finance/medicare-advantage-organizations-overturned-75-of-their-denials-fed-investigation-shows.html