Top drivers of hospital claim denials

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Accounting for 34 percent of denied claims, bundling errors remained the top reason hospital charges were denied in 2021, according to an Oct. 28 report from Hayes Management Consulting.

For the study, the revenue integrity software provider and consultant analyzed $100 billion worth of denials and $2.5 billion in audited claims. 

Here are the top reasons inpatient claims were denied, according to Hayes:

1. The benefit was included in a different service or procedure that was already adjudicated.

2. The charges were covered under a capitation agreement.

3. There was missing documentation.

4. The claim contained a submission error or billing error.

5. It was a duplicate claim. 

6. There was a maximum benefit overreach.

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