Impact of Rising Denial Rates on Healthcare Revenue Cycles: How Allzone's RCM Services Can Help




Denial rates, particularly evident in Medicare Advantage, are increasing, impacting both the revenue cycles of hospitals and the quality of patient care, according to the executive director of a large Minnesota-based healthcare organization specializing in Revenue Cycle management. Despite the organization reporting a positive margin this year, it falls behind in generating profits comparable to those of insurers, notably national ones, which continue to face challenges in processing claims, as highlighted by the executive director.

The healthcare organization aims to maintain its cost-to-collect at 2%, prioritizing efficiency rather than solely focusing on addressing denials. However, the current rate sits at approximately 7%, signifying a significant deviation from the desired target.

The executive director expressed concern about the substantial costs incurred by the organization, attributing a considerable portion of claim denials to the utilization of artificial intelligence in algorithms.

Health insurance plans are confronting a class action lawsuit alleging the improper use of an artificial intelligence algorithm to reject rehabilitative care for Medicare Advantage patients who are unwell. Likewise, Healthcare Company is also the target of a lawsuit alleging that the Cigna PXDX algorithm automatically denies treatments that don't meet predetermined criteria, bypassing the necessary individual physician review process.

https://www.allzonems.com/how-claim-denials-and-payer-audits-impacts-healthcare-revenue-cycle/

Why Allzone's revenue cycle management ?

Allzone offers Revenue Cycle Management (RCM) services to healthcare organizations, specializing in optimizing the financial aspects of healthcare delivery.

Here are some Benefits of using Allzone's RCM services:

  • 24/7 customer support

  • Secure data storage and transmission

  • Compliance with HIPAA regulations

  • A variety of reporting tools

Overall, Allzone's RCM services can help healthcare providers to improve financial performance, reduce costs, and focus on providing quality care to your patients. 

 We can assess your needs and develop a customized plan to help you achieve your financial goals.  If you are considering outsourcing your RCM services, please don’t hesitate to reach out to us at 866-854-2714 or sales@allzonems.com . We’re eager to arrange a call and delve into how we can support the success of your healthcare facility.

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