RelayHealth Financial: 1.6% of claims denied post ICD-10

RelayHealth Financial, the revenue cycle management arm of McKesson, reported a denial rate of 1.6 percent for claims processed between Oct. 1, 2015 and Feb. 15, 2016.  

For the study, RelayHealth compiled more than 262 million claims processed between the implementation of ICD-10 and February of this year. More than 2,400 hospitals and 630,000 providers used RelayHealth Financial revenue cycle management solutions during that time.

Of the $810 billion in claims processed, the total denial rate represents $12.9 billion in denied claims since Oct. 1.

"The good news is that we're not seeing a marked increase in claim denial rates, and there is heightened interest in denial management and prevention," said Marcy Tatsch, vice president and general manager of reimbursement solutions for RelayHealth Financial.

On the other hand, a denial rate of one in five claims may correlate to dip in hospital revenue by as much as 3 percent, according to Ms. Tatsch.

Below are the top 10 highest denial rates RelayHealth experienced by payer.

  1. Mississippi Medicaid — 59.7 percent
  2. Washington Medicaid — 10.5 percent
  3. Florida Health Options HMO — 8.2 percent
  4. Great Lakes Health Plan — 7.8 percent
  5. Gateway Health Plant - Medicaid PA — 7.5 percent
  6. Florida Blue Cross — 7 percent
  7. Michigan Medicaid — 6.5 percent
  8. HorizonNJ Health — 6.4 percent
  9. Blue Care Network — 6.1 percent
  10. South Carolina Medicaid — 5.8 percent

RelayHealth Financial launched an online resource for providers to review strategic denial prevention and management issues, including information on best practices, operational considerations, case studies, whitepapers and webinars.


More articles on revenue cycle management: 

NJ slashes $150M from charity care funding to state hospitals
New RelayHealth Financial portal prepares providers for EMR transitions
Change Healthcare to debut patient-focused RCM solutions

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