Jindal Healthcare

The “National Hospital Flash Report: April 2023” indicates that US healthcare providers are struggling with more denials of claims. This problem influences patient treatment and happiness in addition to the financial viability of healthcare companies. Healthcare Denial Management providers have to aggressively simplify their revenue cycle handling system if they want to meet these obstacles. Healthcare providers use this financial system for tracking, billing, and payment collecting of incoming payments. Research and Markets’ projections indicate that by 2030, the RCM market is expected to reach US$238 billion. Today, we will discuss denial management in healthcare; first, you must know the moving elements before starting denial management. What is Denial Management in Healthcare  When a healthcare insurance payer declines to compensate a physician for services delivered to a patient based on their benefits, a claim denial results. A denial of a claim could have hundreds of differe...

Claim denials continue to be one of the most dreaded setbacks for healthcare providers, tormenting their revenue cycle and costing them a staggering  $20 billion  every year. With around $43.84 as the average cost of fighting a claim, the stakes keep getting higher. Shifting payer behavior, fewer hands on deck to deal with the rising patient and claim volume, and heavy reliance on manual claims management result in process inefficiencies and revenue leaks, further adding to their woes. However, there’s some good news:  about 90% of the denials can be prevented  and around 63% can be recovered on appeal. Artificial intelligence (AI) in denial management can be a game-changer for healthcare revenue cycle management (RCM) in this regard.  AI is fast becoming the most sought-after technological aid among healthcare providers to boost operational efficiency through evidence-based process improvements. It has successfully helped digitally transform practices end-to-en...

Claim denials continue to remain a thorn in the side of many providers in the healthcare space. Owing to growing complexities in the regulatory framework and ever-changing payer behavior, there has been a steady rise in denials, underscoring the urgent need for providers to rethink their denial management strategy. These denials not only affect their bottom line but also silently underline the need for revenue cycle management (RCM) solutions that could help providers optimize their operations for improved financial outcomes. To improve the resilience of their revenue cycle with a clean claim rate, healthcare systems need to implement a well-thought-out strategy that can target denials head-on and help them maintain financial stability in the long run. Dive into this blog to explore why claim denials happen and what measures providers can take to make their revenue cycle bulletproof.   Why denials happen Claim denials happen when the insurer or the payer rejects to pay for the serv...

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...