Norristown, Pa. – Nov. 2, 2022 – Ongoing disconnects in denial prevention and management are leading to negative revenue impacts, according to respondents in a recent HFMA survey of healthcare finance and revenue cycle executives, sponsored by MRO, a proven clinical data exchange and interoperability company providing revenue integrity tools. According to the 317 respondents, concerns with clinically avoidable denials are exacerbated by staffing shortages and increases in commercial and managed care audits.  

The survey also found half of healthcare organizations hold more than 3% of total net patient revenue (NPR) in reserves each fiscal year in anticipation of denied claims, with over a third holding back greater than 5% to offset concerns. 

Despite these known denial issues, nearly 40% of organizations surveyed continue to rely on Microsoft Excel spreadsheets to track audits and denials, versus more advanced technological denial management solutions. In addition, less than a quarter of organizations track trends related to clinically avoidable denials.  

“If you’re not tracking, trending and consolidating audit information, you’re potentially missing out on big trends,” said Dawn Crump, MA, CHC, SSBB, senior director of revenue cycle solutions at MRO. “Many organizations lack the insight necessary to take a proactive approach to denial management, due to nonspecific financial work queues, lack of digitized payer communications regarding audits, and interoperability challenges between disparate systems.” 

Here is a snapshot of other survey findings: 

  • Only 7% of respondents receive more than 71% of their government and commercial claim audits electronically.
  • Nearly all (90%) of respondents said it’s “somewhat” or “very” essential for all systems that touch the revenue cycle to share data.

“By digging into the data, establishing a denial tracking system, addressing interoperability and breaking down the silos, organizations can better understand the impact of their clinically avoidable denials,” said Crump. Organizations should also form a centralized revenue integrity function to support better tracking and management of denials while improving collaboration and efficiency. 

About MRO

MRO, a leading clinical data release platform and the KLAS-rated No.1 provider of release of information (ROI) solutions since 2013, empowers healthcare organizations with proven, enterprise-wide solutions for the secure, compliant, and efficient exchange of clinical information. As a single source technology and service provider for health systems and providers, MRO’s EMR integration, workflow and clinical data solutions improve clinical and financial outcomes requiring extraction and interoperability of medical records, structured and unstructured data. These solutions support enterprise-wide applications, including quality measurement and reporting, payer-provider interoperability, clinical denial audit management, clinical registries, release of information, and more. Through innovation, emerging technologies, and deep domain expertise, MRO is connecting over 200 EHR and practice management systems, extracting more than 10,200 clinical data elements, and engaging nearly 200,000 providers, securely, efficiently, and compliantly. For more information, visit www.mrocorp.com.