New Harmony Healthcare Survey of Hospital Leaders Finds More Than 30% of Hospitals Near Danger Zone of Denial Rates

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Today, Harmony Healthcare released recent survey results highlighting the current state of the denials market according to over 130 hospital reimbursement executives.

While the crisis is not fully behind us, we feel that many of the hospitals and healthcare systems we support are ready to pick back up the torch to lower denials and increase recovery to more acceptable levels of performance.

Today, Harmony Healthcare released recent survey results highlighting the current state of the denials market according to over 130 hospital reimbursement executives. As a leader in delivering experts within reimbursement, population health, and information technology, Harmony understands the urgency created within healthcare to address the 20+% increase in denials rates in the last 5 years. The pandemic saw those rates increase even more rapidly, contributing to the need for stronger denials prevention and recovery solutions.

Across the nation, the average denials rate is between 6% and 13%, and over 1/3 of hospital reimbursement executives surveyed responded that their organizations are nearing the denials danger zone of 10%. Key findings include:

  • 33% of hospital executives reported average denial rates of more than 10%
  • 31% of hospital executives reported average denial rates of less than 5%
  • 20% of hospital executives reported average denial rates of 5% - 7%
  • 16% of hospital executives reported average denial rates of 8% - 10%

“The public health emergency understandably diverted attention away from addressing this critical business issue,” said Randy Verdino, CEO of Harmony Healthcare. “While the crisis is not fully behind us, we feel that many of the hospitals and healthcare systems we support are ready to pick back up the torch to lower denials and increase recovery to more acceptable levels of performance.”

Research shows that approximately 85% of denials are preventable, but successfully preventing them requires strengthened leadership and improved skills of hospitals’ prevention and recovery teams. Hospital reimbursement leaders reported a variety of high dollar concerns when it comes to denials and their strategies in preventing them. Key findings include:

  • 32% of respondents reported their top concern as coding
  • 30% of respondents reported their top concern as medical necessity acute IP
  • 20% of respondents reported their top concern as front end
  • 18% of respondents reported their top concern as clinical validation denials

“Payers continue to deny claims, so facilities and the revenue cycle team must focus on finding and correcting systemic issues,” said Lisa Knowles, Harmony’s Senior Director, Client Solutions. “We help our customers determine the root cause and turn appeals and recoveries into prevention. No denial should be hidden, and every win should be celebrated through continuous improvement.”

A total of 131 hospital executives responded to Harmony’s survey conducted via LinkedIn from April 27, 2021 - May 20, 2021.

Harmony Healthcare implements a flexible and pragmatic approach in achieving better results for its customers. Its denials recovery and prevention solution plugs into organizations’ processes at any point. Harmony can lead from evaluation through design and implementation or provide highly qualified talent to fill gaps in organizations’ existing processes.

Founded in 2010, Harmony Healthcare employs over 500 employees across the United States and serves over 300 clients, including 11 of the top 15 largest health systems, along with major academic health centers, hospitals, physician practices, payers, and strategic alliances.

About Harmony Healthcare:
Harmony Healthcare delivers expert consultants within reimbursement, population health, and information technology to providers on a national basis and across all care settings. The company empowers healthcare organization success, enhances clinical and financial outcomes, and enables the transition to value-based healthcare. For more information, please visit https://harmony.solutions/.

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Susan Taylor
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