• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to secondary sidebar
  • Skip to footer

  • Opinion
  • Health IT
    • Behavioral Health
    • Care Coordination
    • EMR/EHR
    • Interoperability
    • Patient Engagement
    • Population Health Management
    • Revenue Cycle Management
    • Social Determinants of Health
  • Digital Health
    • AI
    • Blockchain
    • Precision Medicine
    • Telehealth
    • Wearables
  • Startups
  • M&A
  • Value-based Care
    • Accountable Care (ACOs)
    • Medicare Advantage
  • Life Sciences
  • Research

Change Healthcare: $262B in Healthcare Claims Initially Denied in 2016

by Fred Pennic 06/27/2017 Leave a Comment

  • LinkedIn
  • Twitter
  • Facebook
  • Email
  • Print

Change Healthcare: $262B in Healthcare Claims Initially Denied in 2016

A new analysis by Change Healthcare of $3 trillion in medical claims submitted to payers last year revealed 9% of charges, representing $262 billion, were initially denied. For the typical health system, as much as 3.3% of net patient revenue, an average of $4.9 million per hospital, was put at risk due to denials. While 63% of these claims were recoverable on average, reworking each denial costs providers roughly $118 each, or as much as $8.6 billion in appeals-related administrative costs.

 

Achieving a high level of revenue cycle performance is difficult without contemporary revenue cycle analytics that help pinpoint the process gaps that fuel denials; as well as financial clearance and claims management tools that help ensure claims have accurate, complete data for revenue cycle functions from patient access to billing and follow up.

The Healthy Hospital Revenue Cycle Index is based on primary institutional inpatient and outpatient claims processed by Change Healthcare in 2016. Average charged amount and first denied amount for 724 hospitals in the sample was used to extrapolate total claimed charges and total first denied amounts for all 5,6832 hospitals in the nation. Using Change Healthcare’s average appeal success rate of 63% and average reimbursement rate of 29%, $4.9 million per hospital is the annual final denied amount.

The analysis found in the Healthy Hospital Revenue Cycle Index is just one of many reasons why hospitals and health systems should consider implementing contemporary analytics software. In doing so, healthcare organizations can help bridge the inefficiency gap of how denials are processed resulting in improved revenue cycle efforts and increased cash flows. 

The Index also breaks down denial trends by geographic region and organization size, and provides revenue cycle executives the ability to quickly benchmark their organization’s revenue cycle health against peers nationwide.  

 

“Eye-opening insights like these are only possible with advanced analytics and revenue cycle tools that let you identify the root causes of denials, and implement and automate practices that prevent them,” said Marcy Tatsch, senior vice president and general manager, Reimbursement and Analytics Solutions, Change Healthcare in a statement. “You can’t fix what you can’t see. But by reinventing the revenue cycle with analytics, a hospital can improve its success rate in appealing denied claims and increase how much revenue is recovered—not to mention reducing the number of denials in the first place.”

  • LinkedIn
  • Twitter
  • Facebook
  • Email
  • Print

Tagged With: Change Healthcare, Healthcare Claims, Revenue Cycle Management

Tap Native

Get in-depth healthcare technology analysis and commentary delivered straight to your email weekly

Reader Interactions

Primary Sidebar

Subscribe to HIT Consultant

Latest insightful articles delivered straight to your inbox weekly.

Submit a Tip or Pitch

Featured Insights

2025 EMR Software Pricing Guide

2025 EMR Software Pricing Guide

Featured Interview

Paradigm Shift in Diabetes Care with Studio Clinics: Q&A with Reach7 Founder Chun Yong

Most-Read

Medtronic to Separate Diabetes Business into New Standalone Company

Medtronic to Separate Diabetes Business into New Standalone Company

White House, IBM Partner to Fight COVID-19 Using Supercomputers

HHS Sets Pricing Targets for Trump’s EO on Most-Favored-Nation Drug Pricing

23andMe to Mine Genetic Data for Drug Discovery

Regeneron to Acquire Key 23andMe Assets for $256M, Pledges Continuity of Consumer Genome Services

CureIS Healthcare Sues Epic: Alleges Anti-Competitive Practices & Trade Secret Theft

The Evolving Role of Physician Advisors: Bridging the Gap Between Clinicians and Administrators

The Evolving Physician Advisor: From UM to Value-Based Care & AI

UnitedHealth Group Names Stephen Hemsley CEO as Andrew Witty Steps Down

UnitedHealth CEO Andrew Witty Steps Down, Stephen Hemsley Returns as CEO

Omada Health Files for IPO

Omada Health Files for IPO

Blue Cross Blue Shield of Massachusetts Launches "CloseKnit" Virtual-First Primary Care Option

Blue Cross Blue Shield of Massachusetts Launches “CloseKnit” Virtual-First Primary Care Option

Osteoboost Launches First FDA-Cleared Prescription Wearable Nationwide to Combat Low Bone Density

Osteoboost Launches First FDA-Cleared Prescription Wearable Nationwide to Combat Low Bone Density

2019 MedTech Breakthrough Award Category Winners Announced

MedTech Breakthrough Announces 2025 MedTech Breakthrough Award Winners

Secondary Sidebar

Footer

Company

  • About Us
  • Advertise with Us
  • Reprints and Permissions
  • Submit An Op-Ed
  • Contact
  • Subscribe

Editorial Coverage

  • Opinion
  • Health IT
    • Care Coordination
    • EMR/EHR
    • Interoperability
    • Population Health Management
    • Revenue Cycle Management
  • Digital Health
    • Artificial Intelligence
    • Blockchain Tech
    • Precision Medicine
    • Telehealth
    • Wearables
  • Startups
  • Value-Based Care
    • Accountable Care
    • Medicare Advantage

Connect

Subscribe to HIT Consultant Media

Latest insightful articles delivered straight to your inbox weekly

Copyright © 2025. HIT Consultant Media. All Rights Reserved. Privacy Policy |