9 workflows driving your claim denials, ranked

Every practice has a theory about why claims come back, and it is usually shaped by whoever complained most recently. The biller who keeps seeing the same payer reject. The front-desk lead tired of chasing insurance cards. The coder who is convinced nobody reads the documentation.

Inovalon, a health care data and analytics company, put the question to more than 400 revenue cycle leaders and managers for its report "Claim Denials: Prevention Strategies." Respondents came from ambulatory physician practices (42%), skilled nursing facilities (25%), hospitals and health systems (16%) and home health and hospice (14%), and all were screened for knowledge of initial claim denials. They were shown a list of workflows and asked which ones contribute to denials at their organization. They could pick more than one, and 73% did.

Denials outranked every other revenue cycle problem in the survey. Seventy-two percent called them a significant challenge, ahead of patient payment collection at 71%, patients with unknown or incomplete benefits at 59% and prior authorization at 56%. Seventy-eight percent traced their denied claims to at least one front-end workflow.