The Impact of Claim Denial Triggers on Healthcare
It is no secret that the constantly increasing volume of claim denials is one of the most pressing challenges for providers already grappling with staff burnout and rising operational costs. Most of these denials are recurring and systemic in nature, affecting the entire revenue cycle, and therefore, demand a thorough root cause analysis and a robust feedback mechanism for their prevention. Moreover, denial prioritization is essential while working accounts receivable (AR) to prevent revenue loss, which is a pain point for providers. A recent study by the Healthcare Financial Management Association (HFMA) revealed that unresolved denials can cost providers up to 5% of their net patient revenue, underscoring the need for robust claim denial management . Another report by the American Hospital Association (AHA) that surveyed 1,300 health systems and hospitals highlighted a staggering surge of 56% in Medicare Advantage denials and a 20% spike in commer...