Providers Are Pushing Back on Denials in Medical Billing. Is it Your Time to Join?

Healthcare providers across America burned almost $20 billion dollars in 2022 on medical billing accounts receivable – and it all went to chasing down denials and delays with payers [1]. The numbers look even more disheartening with a focus on private plans. 

What’s worse is over half of that spend was wasted on claims that should have been paid when the claim was submitted – payers are burning provider resources as a stall tactic. A survey of 516 acute care hospitals found that almost 15% of all claims submitted to private payers are denied from the beginning. 

This is money, time, and effort that can be better spent. Healthcare providers face the most complex revenue cycle environment in history, with advancements like AI being used against them – which is why now is the time providers should consider taking a new kind of action. 

So, I was glad to see the news in July that The Health Equality Network stepped up to send a letter to CMS about the problem of medical billing denials, also including a range of congress members. Here are some of my favorite points [2]: 

• “Claims are often denied without cause and lead to financial and emotional distress for individuals already burdened with the stress of healthcare issues.”
• “Medicare Advantage plans…are now inundated with prior authorization requirements and coverage denials.”
• “They (UnitedHealthcare) were sued last year for using an artificial intelligence algorithm to wrongfully deny elderly patients care.”
• “Insurance denials and prior authorization requirements affect minority and lower-income populations at a much higher rate.”

The main takeaway is that providers should focus now on tracking denials in medical billing and understanding the impact of how much money and staff time is being wasted. As more providers push back on this disturbing trend, everyone should be able to make a case for how they, their staff, and their patients are being impacted. 

For many providers, doing this in an accessible and accurate way will mean outsourcing medical billing by working with a third-party vendor who has perspective on whether their investment is normal or whether they’re being taken advantage of. I am proud that 3Gen can offer this kind of support during times like these.