March 27, 2018

Claims Management Facts You’ll Wish You Didn’t Know

Most of us are so busy there isn’t time to stop and think about wasted time and effort.  Here are a few data points to get you thinking about your current claims management process.  Are you working HARD instead of SMART?

Here’s what it costs healthcare providers in the US each year in wasted time and money because of inefficient processes:

  • Manual claim status checking takes 5-12 minutes on average and costs $9.79 per inquiry
  • 30% of claims aren’t paid the first time and are either denied, lost or ignored
  • Denials cost an average of $1.18 per claim to recoup the money
  • 90% of denials are preventable
  • The average cost to rework a denied claim is $25

Of the $3 trillion spent each year on healthcare in the US:

  • $0.15 of every $1.00 goes to revenue cycle inefficiencies
  • $400 billion goes to claims processing, payments, billing, and bad debt



SOURCES: 1  Bayley, MD, Matthew; Calkins, Sarah; Levine, MD, Ed; and Machado-Pereira, Monisha.     “Hospital revenue cycle operations: Opportunities created by the ACA.” 2008 2  “2016 CAQH Index: A report of healthcare industry adoption of electronic business transactions and cost savings.”     CAQH Explorations, 2017 3  “Adhering to These 3 ASC Billing Best Practices Can Streamline Your Revenue Cycle Management.” June 13, 2017. Web. July 25, 2017 4  Guarino, Mary. “How to improve your clean claims rates.” October 19, 2010 5 Barkholz, Dave. “Insurance claim denials cost hospitals $262 billion annually.” Modern Healthcare. June 27, 2017 6 Haines, Morgan. “An Ounce of Prevention Pays Off: 90% of Denials are Preventable.” At the Margins. December 2014 7  Taufen, Amber. “How to avoid unclean claims.” March 28, 2014