The Hard Truth About
CLAIM DENIAL APPEALS
WHAT’S HAPPENING?
Healthcare organizations’ claim denial appeal success rate down

11% for private payers
10% for Medicaid1

607,000 CASES
in the Medicare appeals BACKLOG as of June 20172
 
 
HOSPITALS SPEND
$10,000-$100,000
per quarter managing Medicare Recovery Audit Contractor (RAC) appeals3
 
 
3 YEARS

the amount of time it takes to adjudicate Medicare reimbursement disputes4

 
 
$25
the average cost to providers to rework one claim5
 
 
30 MINUTES
the amount of time to complete appeal documentation6
WHAT’S AT STAKE FOR PROVIDERS?
1 in 10 revenue dollars are at risk for nonpayment7
of denials are never worked by provider, resulting in 5% net revenue loss8
increase in denial write-offs since 20119
 
 
 
 
of providers use manual claims denial processes10
 
 
WHAT’S THE ANSWER?
67% of denials can be appealed11
Waystar’s Denial and Appeal
 
 
Management solution provides:
Workflow automation
that can save providers up to 25 minutes per appeal12
 
 
 
 

Extensive
search tools

with access to both denial reasons and remarks
Productivity
boost
for your teams

1] LaPoint, Jacqueline. “Hospitals Write Off 90% More Claim Denials, Costing up to $3.5M,” RevCycle Intelligence, November 21, 2017.
[2] LaPointe, Jacqueline. “Expanded Resolution Process Opens to Lower Medicare Appeals Backlog,” RevCycle Intelligence, May 31, 2018.
[3] LaPointe, Jacqueline. “Top 4 Claims Denial Management Challenges Impacting Revenue,” RevCycle Intelligence, March 10, 2017.
[4] LaPointe, Jacqueline. “Expanded Resolution Process Opens to Lower Medicare Appeals Backlog,” RevCycle Intelligence, May 31, 2018.
[5] Wyatt, Chris. “Optimizing the Revenue Cycle Requires a Financially Integrated Network,” HFMA, July 7, 2015.
[6] Stop the Write-Offs: 7 Strategies to Improve Cash Flow, Waystar, 2018.
[7] Taylor, Mark. “Increasing Payer Denials, Uninsured Challenge Hospital RCM,” HFMA, December 7, 2017.
[8] LaPointe, Jacqueline. “3 Best Practices for Hospital Claim Denials Management,” RevCycle Intelligence, May 11, 2017.
[9] LaPointe, Jacqueline. “Hospitals Write Off 90% More Claim Denials, Costing up to $3.5M,” RevCycle Intelligence, November 21, 2017. 
[10] LaPointe, Jacqueline. “Top 4 Claims Denial Management Challenges Impacting Revenue,” RevCycle Intelligence, March 10, 2017.
[11] Dahmen, Rochelle. Implementing an Effective Denials Management Program, Eide Bailly.
[12] Denial Productivity ROI, Waystar, 2018.

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