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.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.