Kodiak Solutions' latest RCA benchmarking analysis shows higher denial rates from commercial insurers and Medicare Advantage plans are driving huge increases in accounts receivable (AR) aged more than 90 days.
INDIANAPOLIS, Dec. 13, 2023 /PRNewswire-PRWeb/ -- For hospitals, health systems and medical practices, claims initially denied are increasingly becoming payments too long delayed.
Healthcare provider organizations are waiting longer to receive payment for services, with the value of claims taking longer than 90 days to be paid having increased since 2020 by 33% for commercial insurers and more than 40% by Medicare Advantage (MA) plans, respectively. Those are among the latest findings from data collected by Kodiak Solutions (formerly Crowe healthcare consulting) and analyzed in its latest quarterly revenue cycle benchmarking report, "The Healthcare Revenue Cycle Waiting Games."
Kodiak Revenue Cycle Analytics (RCA) software monitors every patient financial transaction from more than 1,800 hospitals and 200,000 physicians nationwide. Kodiak analyzes data gathered from RCA clients to monitor payor behaviors and provide actionable insights to support targeted performance discussions with payors.
Initial denials up nearly 20%
Kodiak RCA data analysis shows that the leading driver of accounts aged more than 90 days is the surge in initially denied claims: According to the report, the initial claim denial rate as a percentage of claim value in 2020 was 10.15% and rose to 11.99% through the third quarter of 2023, an 18.1% increase.
"Resolving these payor denials requires a significant investment of time, resources and management attention from revenue cycle departments," said Colleen Hall, senior vice president and Revenue Cycle leader at Kodiak Solutions.
"The initial denials cause delays sending bills to patients, and the longer patient billing is delayed after a procedure or hospital stay, the lower the collection rate for providers," Hall said. "This amplifies the financial impact on provider organizations at a time when they are already under tremendous financial pressure."
The quarterly benchmarking report also revealed:
- Through the third quarter of 2023, commercially insured patients are responsible for about 23% of their medical bills, including both inpatient and outpatient care.
- Aged accounts receivable (AR) greater than 90 days as a percentage of claim value for patients with commercial insurance reached 36% for 2023 through the end of the third quarter compared with 27% for 2020. The percentage for MA-insured patients rose to 27% through the end of the third quarter of 2023 compared with 19% in 2020.
- Through the third quarter of 2023, self-pay after insurance collection rate for commercially insured patients as a percentage of claim value was 36.1%.
"Health systems that want to mitigate these challenges can enhance their communication with patients from the date of service to the billing date," Hall said. "When patients receive clear and prompt updates from providers, it reduces the possibility of overlooked medical bills and can increase the likelihood of on-time payment."
To view the full report, please visit "The Healthcare Revenue Cycle Waiting Games."
About Kodiak Revenue Cycle Analytics benchmarking data
Over 1,800 hospitals and more than 200,000 physicians use the Kodiak RCA solution to capture every patient transaction for purposes of automating hindsight, providing accounts receivable valuations, and analyzing net revenue. This proprietary benchmarking solution that monitors revenue cycle performance through normalized key performance indicators at healthcare organizations across 47 states and tracks more than $800 billion in combined annual gross revenue.
About Kodiak Solutions
Kodiak Solutions is a leading technology and tech-enabled services company that simplifies complex business problems for healthcare provider organizations. For nearly two decades as a part of Crowe LLP, Kodiak created and developed our proprietary net revenue reporting solution, Revenue Cycle Analytics. Kodiak also provides a broad suite of software and services in support of CFOs looking for solutions in financial reporting, revenue cycle, risk and compliance, and unclaimed property. Kodiak's 400 employees engage with more than 1,800 hospitals and 200,000 practice-based physicians, across all 50 states, and serve as the unclaimed property outsourcing provider of choice for more than 2,000 companies. To learn more, visit our website.
Media Contact
Vince Galloro, Kodiak Solutions, 1 (312) 625-2137, [email protected], https://www.crowe.com/services/consulting/healthcare
SOURCE Kodiak Solutions
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