Insights Revealed: Unpaid Hospital Bills & Payer Rejections Impacting Revenue Cycles




Unpaid hospital bills persisting beyond 90 days often trace back to initially rejected claims by payers, as revealed in a recent Healthcare Consulting Company report. Using advanced revenue cycle analytics software monitoring patient financial activities in over 1,800 hospitals and 200,000 physicians, the report brings attention to several key insights.

The report's quarterly benchmarking analysis highlights a substantial surge in the value of outstanding claims surpassing the 90-day mark across various sectors. Notably, there's been a 33% increase in such claims for commercial insurers and a striking 40% surge for slow claims associated with Medicare Advantage. Furthermore, the report notes an 18% rise in the initial claim denial rate, climbing from 10% to 12% between 2020 and the third quarter of 2023.

Additional significant findings from the report include:

  • Approximately 23% of medical expenses, encompassing both inpatient and outpatient care, were borne by patients with commercial insurance up until the third quarter of 2023.
  • The percentage of accounts receivable aged over 90 days relative to claim value spiked to 36% for patients under commercial insurance by the end of the third quarter in 2023, up from 27% in 2020.
  • Patients covered by Medicare Advantage witnessed a rise to 27% of accounts receivable aged over 90 days by the end of the third quarter of 2023, a jump from 19% in 2020.
  • By the third quarter of 2023, the self-pay after insurance collections rate for patients with commercial insurance stood at 36.1% of the claim value.

https://www.allzonems.com/rising-denied-claims-impact-on-hospitals-cashflow-delays/

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