Denials of claims are increasing, along with the administrative burden of managing them.
Here are five things to know:
1. In 2024, 77% of respondents noted that payer policy changes are happening more frequently, up from 67% in 2022, according to Experian Health's "2024 State of Claims" survey.
2. Additionally, 67% of respondents said reimbursement times are increasing in 2024, compared to 51% in 2022.
3. The most common reasons for claim denials were missing or inaccurate data (46%), authorization issues (46%), and incomplete or inaccurate patient information (30%).
4. Anecdotally, physicians are seeing an increase in claims denials amid rising payer obstacles.
"We as physicians have very little, if any, opportunity to speak with payers. If we are lucky, I get to speak to a 'claims specialist' to argue about why I am not being paid," Ravi Krishnan, MD, an ophthalmologist at The Eye Institute of Corpus Christi (Texas) told Becker's. There is some so-called negotiation of the payment schedule beforehand, but as an owner of a small solo practice, I have very little bargaining power."
5. Payers are also challenging physicians to secure reimbursements with prior authorization policies. Nearly 97% of providers have seen delays or denials for necessary patient care due to PA requirements, according to the Medical Group Management Association's 2023 "Regulatory Burden Report." Additionally, PA denials for outpatient care claims jumped 16% in the last three years.