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Bridging the payer-provider divide

  A strong move toward payer-provider collaboration is needed to alleviate animosities that sow widespread confusion around payment across the nation’s healthcare system. The health system had terminated its managed care contracts with the payer when negotiations over reimbursement rates that failed to keep up with expenses came to an impasse. After an intense media campaign, legal action and a strategy backed by data, the organizations finally reached an agreement. Despite that experience, even Mounts is surprised by the degree to which she says payers have, in recent years, been unsympathetic about the cost pressures hospitals and health systems face, particularly following the pandemic. Mounts once got into an argument with a payer executive who said inflation was getting better at a time when inflation clearly was not. “When I would point to any number of sources, including our own internal data and financial statements, to show them the increases in expenses that we were exper...

Breaking down claim denial rates by healthcare payer

  Rising claim denial rates challenge healthcare providers, increasing revenue losses, staff burden and patient dissatisfaction, with private payers denying more claims. More healthcare providers are reporting higher claim denial rates than before, according to a recent  survey  from Experian Health. With rates rising, providers are experiencing revenue cycle management and patient experience challenges. Higher claim denial rates lead to lost revenue and delayed reimbursement while creating more work for revenue cycle staff who must chase down payments and launch appeals for denied claims. In fact,  denials management was the most time-consuming revenue cycle management task  for healthcare financial leaders, according to a 2023 survey from AKASA. Patients are also becoming increasingly disgruntled by claim denials. Claim denials have recently been put in the spotlight after the  death  of UnitedHealthcare's CEO Brian Thompson, which has sparked a larg...