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.
