From Denials to Dollars: RCM Company’s Role in Financial Health



Revenue Cycle Management Company stands at the forefront of transforming healthcare facilities and wellness systems by addressing patient-centric coordination of benefits and clinical disputes, recovering low-balance accounts, and resolving intricate claims.

Swift and efficient resolution of these facets of the revenue cycle has become a top priority, given the significant financial pressures healthcare providers are facing. The increasing urgency to enhance denial management amplifies the importance of resolving these aspects promptly. Delays or denials in payment for services pose challenges for healthcare providers in sustaining workforce, covering operational costs, making essential investments in facilities and technology, and maintaining sufficient cash reserves to withstand market shifts and unforeseen events like natural disasters or mass casualty incidents.

Denials: A Changing Landscape:

Denials in the healthcare landscape are undergoing a transformation, and a considerable portion of revenue loss is attributed to the rising number of denied claims confronting hospitals. According to the latest data from industry advisor Kodiak (formerly Crowe), tracking information from over 1,800 hospitals and 200,000 doctors, the average inpatient denial rate has increased from 11% to 14% from 2020 to Q3 2023. For a typical hospital, an 11% denial rate can translate to more than 110,000 unpaid claims.

Complicating matters further, the landscape for reimbursement is poised to become even more challenging. Payer capabilities are on the rise, and several private payers have acquired artificial intelligence companies in recent years, potentially leveraging automated decision-making to further increase denial rates.

Simultaneously, hospitals face challenges in allocating resources to combat denials. Staffing shortages in the revenue cycle continue to be a hurdle for many organizations, especially for trade office positions requiring specialized skills or experience. Hospitals and health systems increasingly rely on partners like Revenue Cycle Management Company to handle the intricacies of time-intensive eligibility issues and access the necessary legal and clinical expertise to address denials related to medical necessity or utilization issues.

The Revenue Cycle Management Company team consists of experienced medical professionals, lawyers, and coordination of benefits and offers specialists, many of whom have a background on the payer side. Leveraging a comprehensive view of payment trends and performance data to identify best practices, they empower hospitals to recover more revenue from claims and achieve faster resolutions.


https://www.allzonems.com/optimize-revenue-with-expert-healthcare-rcm-company/ 

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