Healthcarercm

  The healthcare industry is facing an unprecedented challenge in managing claim denials. With denial rates climbing post-pandemic and the complexity of appeals increasing, healthcare organizations face immense pressure to combat revenue leakage, address operational inefficiencies, and mitigate the confusion and frustration that denials contribute to patient dissatisfaction. The time-consuming manual nature of the appeals process, exacerbated by high staff turnover and limited automation adoption, has left many healthcare organizations overwhelmed and unable to adapt to changing payer strategies. Challenges in Appeals Management Studies indicate that over $12 billion is lost annually due to denied claims. Time-consuming processes and staff shortages mean that more than 50% of denial inventory is not appealed. Among those that are appealed, the average cost approaches $200 per case, with complex clinical denials often incurring even higher expenses. Despite the efforts, only 54% of ...