GE Healthcare Uncovers $2 Billion of Actionable Denials for U.S. Healthcare Providers
February 20 2017 - 2:53PM
Business Wire
GE Healthcare has uncovered $2 billion1 of actionable health
insurance claim denials for its customers since January 2016. Of
the $2 billion, approximately 30 percent of those denials result
from coding issues, costing providers on average between $9 and $24
million per year. Another 19 to 22 percent of those denied claims
stem from eligibility discrepancies, resulting in an average of $6
to $15 million in lost revenue. Also among the top culprits for
actionable denials are issues with timely filing, prior
authorization and credentials.
GE Healthcare has found that hospitals, on average, lose between
2 and 5 percent of their net patient revenue to avoidable denials.
Those denials are fixable with the help of DenialsIQTM, an advanced
analytics solution using machine learning capabilities to identify
correctable denials and their cause. GE Healthcare is actively
working alongside U.S. healthcare providers to reduce lost revenue
and has seen significant results since launching the solution in
2016.
“In recent years, Ohio ENT and Allergy Physicians has
experienced a rise in denied claims, resulting in high re-work
costs with very little return,” said Rhonda Burge, CPC Billing
Director, Ohio ENT and Allergy Physicians. “Since implementing
DenialsIQ, we have not only identified the source of our denials,
but have started recapturing revenue with new processes.”
Ohio ENT and Allergy Physicians, Ohio’s largest independent ENT
and Allergy group, used DenialsIQ to help reduce coding denials by
24 percent, improving coding performance by $95k from January 2016
to December 2016. In that time, the provider has decreased its
denied charges by 10 percent by working to redesign workflows and
financial operations based on its insights.
“In this challenging economic environment, healthcare providers
are seeking new ways to address quality, cost and access issues by
looking to unique purchasing, imaging and clinical productivity
solutions,” said Jon Zimmerman, General Manager of Value Based
Care, GE Healthcare. “Yet in the back office, many providers are
now deploying more advanced tools to address the source of
unnecessary financial loss – insurance claim denials – and making
significant improvements as a result.”
DenialsIQ uses powerful algorithms originally designed by GE’s
Global Research Center for the company’s aviation business. Similar
to online shopping software that prompts a user with product
recommendations, DenialsIQ shows administrators hidden patterns and
root cause factors before medical claims denials negatively impact
the revenue cycle.
It is estimated that, of the one in every five claims that’s
denied, it will cost a typical health system, on average, $25 per
claim to re-process. For a $1 billion health system, reducing
claims denials can yield a 0.5 to 1 percent lift in operating
margin - amounting to $5 to 10 million annually.
About GE Healthcare
GE Healthcare provides transformational medical technologies and
services to meet the demand for increased access, enhanced quality
and more affordable healthcare around the world. GE (NYSE: GE)
works on things that matter - great people and technologies taking
on tough challenges. From medical imaging, software & IT,
patient monitoring and diagnostics to drug discovery,
biopharmaceutical manufacturing technologies and performance
improvement solutions, GE Healthcare helps medical professionals
deliver great healthcare to their patients. For more information
about GE Healthcare, visit our website
at www.gehealthcare.com.
1 Averaged across its customer base, excluding Centricity
Practice Solutions
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GE HealthcareSaige Smith+1 262 289 7065Saige.smith@ge.com
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