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RCM's Cash Flow Crunch

by MiddleGate, on May 7, 2019 9:56:22 AM

The True and Agonizing Cost of Underpayments/Denials

The facts

Gross charges underpaid is between 15%-20% of the total billed amount 

The cost to work a denial is $25 per claim 

It takes 16 days longer for a denied claim to pay versus a non-denial 

Changing Payer Behavior

The health insurance industry lacks consistent policies and procedures, which makes your job much harder. Each Payer has its own rules and policies that are continuously changing; causing you stress and anxiety. IT HAS BECOME A CLAIM GAME.

The American Medical Association sheds further light on the challenges in revenue cycle:

“The wide variation in how often health insurers deny claims, and the reasons used to explain the denials indicates a serious lack of standardization in the health insurance industry,” 

The Consequences

Revenue cycle companies are experiencing cash flow challenges that directly impact them and their customers.

Increasing underpayments/denials means increased payroll costs, reduced profit, and an increase risk to the sustainability of the business.

Topics:The Claim GameRCM


About MiddleGate

MiddleGate delivers technology solutions to improve revenue cycle management. Get the latest updates on our blog where we aim to deliver relevant, cutting edge news and commentary on technology issues within medical billing and RCM. 

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