Healthcare claim denials reached an alarming 15% of all claims submitted to private payers in 2024, with providers spending an estimated...

Healthcare organizations are facing an unprecedented surge in claim denials, with 77% of providers reporting increased denial rates from...

Nearly 15% of all healthcare claims submitted to payers for reimbursement are initially denied, with more than half eventually overturned...

Nearly three in four healthcare providers report that insurance claim denials have increased between 2022 and 2024, with approximately 38% of survey respondents indicating that at least one in ten claims are denied ( Experian Health, 2024 ). Among these denials, those based on medical necessity represent a significant and persistent challenge for healthcare organizations, adding administrative burden and threatening financial stability. Understanding Medical Necessity Denials

Healthcare providers are experiencing increasing financial pressure, with PwC projecting an 8% year-on-year medical cost trend in 2025 for the Group market, driven by inflationary pressure, prescription drug spending, and behavioral health utilization ( PwC, February 2025 ). Meanwhile, mergers and acquisitions in the healthcare sector demonstrated continued resilience in 2024 despite a 9% decline in deal volume from 2023 ( Fierce Healthcare, January 2025 ). In this complex fi

According to recent data, Recovery Audit Contractors (RACs) recovered over $2 billion in improper payments in FY 2021 alone, creating a significant financial burden for healthcare providers already operating on thin margins ( Auditec Solutions, 2024 ). What makes these audits particularly challenging is their post-payment nature—they target revenue that has already been accounted for and often spent, forcing hospitals to unexpectedly return funds they believed were secured. I

According to Experian Health's 2024 State of Claims report , a staggering 73% of healthcare providers report that claim denials are increasing, while 67% feel it's taking longer to get paid. These rising denial rates represent a significant financial challenge, with hospitals spending an estimated $19.7 billion in 2022 trying to overturn denied claims, according to the American Hospital Association . For hospital administrators, developing a strategic approach to appealing in

Introduction Recent data from the American Hospital Association reveals that between 2022 and 2023, Medicare Advantage claim denials increased by a staggering 55.7%, representing billions in contested revenue for U.S. hospitals (AHA, September 2024) . With hospital operating margins hovering at just 2.5%, DRG downgrades represent a significant threat to financial sustainability. This guide provides hospital administrators with a practical, step-by-step approach to identify, p

Hospitals lose $19.7B annually fighting denials, yet 54% get overturned on appeal. This guide shows how AI automation reduces appeal time from 4 hours to 15 minutes while increasing success rates. Start reclaiming your revenue today. Nearly 15% of all medical claims submitted to private payers and approximately 16% of Medicare Advantage claims were initially denied in 2024, with inpatient care facing an even higher denial rate of 14.07% ( Premier Inc., February 2024 ). This c

ProPublica reveals how EviCore uses AI to deny healthcare claims, transforming patient restrictions into profits.