In the world of medical services it is no secret that the revenue cycle can be severely interrupted if not completely stopped when a medical claim filed is denied. This break in the rev cycle has been under much scrutiny and close watch by medical officials and stakeholders, especially since the switch to ICD-10. There was nervousness over how dramatically claim denials would increase after the new codes were implemented – now this anxiety has been exchanged for determination to minimize the impact that denied claims can and will inevitably have on revenue.
One case study that stands out as a self-starter for taking initiative in this area is Orlando Health. With 6 acute Care Hospitals, 15,132 team members and 2,995 beds, Orlando Health was interested in investigating how to reduce their percentage of denied claims and maintain the industry benchmark between 2-4 percent. Their discovery after seeking advice from an outside consulting group left administrators concerned that they were heading for trouble, when told they already ranked above the national average and were losing millions of dollars in revenue every year.
