News: 33% of hospitals’ denial rates are in the ‘danger zone,’ survey finds

Thirty-three percent of hospital executives said their organization’s average rate of denials is in the “danger zone” (i.e., more than 10% of all claims), according to a recently released survey by Harmony Healthcare. The findings were based on a survey of 131 hospital executives surveyed via LinkedIn between April 27 and May 20, according to Becker’s Hospital Review.

The survey found that

• 33% said their average denial rates were more than 10%
• 16% said their average denial rates were between 8% and 10%
• 20% said their denial rates were between 5% and 7%
• 31% said their average denial rates were less than 5%

Approximately 85% of denials are preventable but preventing them requires strengthened leadership and improved skills of hospitals’ prevention and recovery teams, according to Harmony Healthcare’s release. According to survey respondents, their top denial concerns were:

• Coding (32%)
• Medical necessity for acute inpatient stays (30%)
• Front-end processes (20%)
• Clinical validation (18%)

Editor’s note: To read Becker’s Hospital Review’s coverage of this story, click here. To read the release from Harmony Healthcare, click here. To read a CDI Journal article about using denial volumes as a CDI key performance indicator, click here.