In the US, 10 % of all claims submitted by Healthcare Providers are denied
That all adds up to $280+ Billion per year in denials – Only 65% of those denied claims are ever resubmitted
Sharecare Can Help
Healthcare Providers need to focus their time and efforts on providing appropriate and timely health care to patients. But the hard truth is that providers spend a large percentage of their time and resources simply trying to get paid for providing care to patients.
Payors’ reasons for denying claims can vary widely from claim to claim, from simple coding and procedural errors to more complex reasons around the quality of care and necessity of treatment. With improved FWA detection technologies being implemented by major Payors, denial volume is also rising, sweeping honest Provider’s errors into the same FWA pile as actual “bad FWA actors”.
10% of all healthcare claims in the US are denied by Payors, and only 65% of those denied claims are ever resubmitted. The number one reason for not resubmitting claims is the cost and administrative burden.
And denials are on the rise with some industry sources showing denials for hospital claims increasing 23% from 2016 to 2020. As an example, according to Medscape‘s “Physician Compensation Report 2020”, 19% of claims General Surgeon’s claims are denied.
Medscape surveyed 17,461 U.S. clinicians and found that the rate of claim denials and resubmissions can vary from specialty to specialty, but has a significant impact across the board:
- Plastic surgery: 28 %
2. Emergency medicine: 22 %
3. Radiology: 20 %
4. Critical care: 20 %
5. General Surgery: 19 %
6. Physical Medicine and Rehabilitation: 19 %
7. Anesthesiology: 19 %
8. Orthopedics: 18 %
9. Pulmonary medicine: 18 %
10. Neurology: 18 %
11. Infectious diseases: 18 %
12. Rheumatology: 17 %
13. Urology: 17 %
14. OB-GYN: 17 %
15. Allergy and immunology: 16 %
16. Oncology: 16 %
17. Psychiatry: 16 %
18. Gastroenterology: 16 %
19. Dermatology: 15 %
20. Internal medicine: 15 %
21. Cardiology: 15 %
22. Nephrology: 14 %
23. Family medicine: 14 %
24. Otolaryngology: 13 %
25. Pediatrics: 13 %
26. Diabetes and Endocrinology: 13 %
27. Ophthalmology: 13 %
The Solution: Sharecare Denial Management Services
In response to Provider’s growing needs for support and assistance with denied claims, Sharecare has introduced Sharecare Denial and Audit Management Services, combining advanced technology with expert personnel and rigorous processes in a unique denied claims solution that resolves unpaid claim issues as well as lowering a Provider’s future denial rates.
The “technology + people + process” approach embodied in these services offers a healthcare Provider access to time-saving technology, trained denial and audit personnel, and proven processes that not only recover revenue now but pay dividends through fewer denied claims and audits in the future.
Sharecare can help you get paid for the care you provide while letting you keep your focus where you want it…on the patient!