Hospital revenues continue to fall due to increasing payer delays, denials

Commercial payers' failure to reimburse providers in a timely manner is "directly impacting hospitals' financial performance," according to a report from public accounting, consulting and technology firm Crowe.

Crowe's revenue cycle analytics software monitors every patient financial transaction from more than 1,800 hospitals and 200,000 physicians nationwide, according to a May 17 news release from the company. Crowe uses the data gathered from its clients to monitor payer behaviors both within specific markets and nationwide. 

The company's analysis of the first quarter of 2023 found that when it comes to denial rates, accounts receivable, bad debt and takebacks, providers are having a "much more favorable experience working with traditional Medicare over commercial insurers."

Four things to know from the report:

1. Commercial payers initially denied 15.1 percent of inpatient and outpatient claims for any reason in the first quarter of 2023. 3.9 percent were denied by traditional Medicare. 

2. In the first quarter of 2023, initial prior authorization denial for inpatient claims for commercial payers was 3.2 percent, compared with 0.2 percent for Medicare. 

3. Thirty-one percent of inpatient claims submitted by providers to commercial payers weren't paid for more than three months in the first quarter of 2023. That figure was 12 percent for Medicare over the same period. 

4. The request for information denial rate for inpatient and outpatient claims submitted by providers to commercial payers was 4.8 percent in the first quarter of 2023, compared to 0.4 percent for Medicare. 

Read the full report here

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