Understanding and Preventing Common Healthcare Insurance Claim Denials (Full Transcript)

Speaker 1: One of the main goals for doctors is to get paid. That's stating the obvious, after all, how else would they stay in business? But in order to get paid, they have to submit patient claims to insurance payers. They rely heavily on their patient's claims to get accepted so they can collect revenue and increase their bottom line. Sounds simple enough, right? Well submitting claims doesn't guarantee that a doctor will actually receive payment. Unfortunately, many claims end up denied, even if they submit appeal letters after the denial happens. Hi everyone, I'm Matt from eTactics and today I'm going to share reasons for insurance claim denials and how often they occur. Before we get started though, make sure you subscribe to our YouTube channel by clicking the button below. While you're down there, hit that alert bell icon next to it as well so when we post new helpful content, you get notified. Many claim denials are avoidable. In fact, up to 86% are potentially avoidable, while 34% are absolutely avoidable. Because they don't have to be inevitable, it's important to know the main reasons for denials. That way, doctors can take steps to prevent them from occurring in the first place. A little over one quarter of denials are due to issues with patient registration and eligibility for the medical claim. In fact, that was the top reason for denials in 2017. Hospital reimbursement leaders also cited their concerns when it comes to denials. 32% cited their top concern as coding and 30% said medical necessity, acute IP. Another 20% cited the front end, while 18% cited clinical validation denials. But how often do these denials happen for hospital leaders to have these concerns? Well, one in seven claims end up denied. I know that might not sound like a lot, but this amounts to over 200 million rejections every day. Even worse, 30% of claims get denied or ignored on the initial submission. Unfortunately, the number of denials has been on the rise, especially since 2020. The COVID-19 pandemic led to more health insurance claim denials. Since the start of it, they've risen 11.1% nationwide. Most of these rates were in the regions with the highest first wave of COVID outbreaks, with a rate of 13.1% in the Pacific Coast and 12.9% in the Northwest. As 2020 went on, denials continued as well. The third quarter of that year shows a 23% increase in insurance claim denials when compared to 2016. Some hospitals are even nearing denial danger zones by this point, and not the ones that are a highway to. Between April and May of 2021, 33% of hospital executives reported rates of 10% or more nearing what's considered this danger zone, thanks Kenny Loggins. These frequencies can vary upon different factors, such as by insurance company or insurance plan. Some rates are nearly 0%, while others are as high as 60%. But either way, many are approaching rates that are problematic, so it makes sense why hospital reimbursement leaders have their concerns. But since most causes are avoidable, practices can work to lower their rates by determining what's contributing to their most frequent denials and being meticulous about them before submission. If you'd like to learn more about healthcare insurance denials and ways to prevent them, reach out to eTactics. And you already made it this far into the video, so you might as well like it, share it, and comment below. Well, what are you waiting for? Subscribe to our YouTube channel.