Knowtion Health Survey: Healthcare Leaders Have Low Confidence in Denials Efforts
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BOCA RATON, Fla., July 23, 2024 ~ A recent survey conducted by Knowtion Health has revealed that hospital CFOs and revenue cycle leaders are facing increasing challenges in meeting cash and cash flow targets. The study, titled "Race for Cash: Pivoting Your Denials Strategy for a New Era," highlights the growing importance of effective denials management and accounts receivable (A/R) management strategies in the face of a changing denials landscape.

According to the survey, 78% of hospital CFOs and revenue cycle leaders believe that hitting cash and cash flow targets will be even more crucial for their organizations over the next three years. This is due to rising denial rates, underpayments, and more complex payment processes, which have put pressure on hospitals' financial performance.

One of the key findings of the study is that 25% of those surveyed anticipate significant challenges in funding long-term capital needs. This highlights the looming cash need for hospitals. Additionally, 57% of hospitals reported denial rates of 10% or more, leading to closer scrutiny on cash and A/R management by CFOs.

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The survey also revealed low confidence in current denials management efforts, with nearly 1 in 5 revenue cycle leaders believing their organization's processes are "not very effective." This is further compounded by the fact that only 49% of those surveyed currently use AI technology in denials management, with 28% not using it at all. However, there is a shift expected in the next three years, with 50% believing adoption of AI technology will be "somewhat likely" and 31% believing it will be "very likely."

Another major barrier to improving revenue recovery from underpayments and denials is a deficit of denials expertise. According to the survey, 37% of leaders cited this as their biggest challenge. Clinical denial appeal writing was also identified as a high pain point.

One revenue cycle leader shared their experience with overwhelming volumes of denials, stating, "Payers are using AI tools to mass downgrade ED levels without reviewing a single record, denying huge dollars of claims. We are audited ad nauseam by vendors hired by payers to retract payment on post-pay reviews. We can't employ enough staff with the appropriate knowledge and skillsets to effectively fight these denials."

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In response to these challenges, Knowtion Health has outlined five practical takeaways for revenue cycle executives on how to ready their teams in their market analysis. According to Jayson Yardley, CEO of Knowtion Health, "In a turbulent payment environment, healthcare organizations can't afford to leave dollars at risk." He further emphasizes the need for proactive strategies in denials management and A/R containment.

Knowtion Health currently serves over 500 hospitals nationwide and manages more than $4.6 billion annually in outstanding balance accounts for clients. Yardley states that their goal is to "tip the balance of power in denials management back to the hospitals and health systems" and help providers level the playing field in insurance claim delays, underpayments, and denials.

To learn more about the market analysis and download it, visit Knowtion Health's website. With growing reimbursement uncertainty and A/R aging, it is crucial for healthcare finance and revenue cycle leaders to be proactive in their denials management strategies. Knowtion Health's study provides valuable insights and recommendations for navigating this changing landscape.
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