The American Medical Association found payers return up to 29 percent of claim lines with $0 for payment, while a MGMA study found more than half of denied claims are never reimbursed. Because the American population is aging and requiring more and more care, healthcare providers are often having to transition patients across different/multiple setting and specials - requiring multiple claims. As a result of these factors, complexity increases.
If providers can begin closing the documentation gap that leads to medical necessity denials, your organization will see a positive impact on your bottom line as well and patient care and satisfaction.
Healthcare providers everywhere are striving to answer this question: How can we better manage denials?