🇦🇺Australia

Denial Risks

2 verified sources

Definition

Simple errors cause denials; manual processes increase rejection risks, leading to revenue loss from non-reimbursed services.

Key Findings

  • Financial Impact: AUD 3-5 per manual PA transaction (vs AUD 0.05 automated); 10-20% claim denials leading to 1-3% revenue loss
  • Frequency: Per authorisation request
  • Root Cause: Lack of real-time payer validation and error-checking

Why This Matters

The Pitch: Australian hospitals face 10-20% denial rates from manual PA, costing millions in rebills. Automation cuts denials by 50% via validation.

Affected Stakeholders

Revenue cycle managers, Coders

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Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Prior Authorisation Delays

AUD 2,400/physician/week (12 hours at AUD 100/hour avg healthcare admin rate); 2-5% revenue leakage from denials/delays

Administrative Burden

AUD 2,400/physician/week; up to 50% capacity loss from delays/denials

Missed Charity Care Write-Offs

AUD 100k-1M+ in annual bad debt per mid-sized hospital (2-5% of revenue leakage from unbilled discounts)

Charity Care Policy Non-Compliance Fines

AUD 10k-100k+ per audit failure or loss of tax benefits/funding

Delayed Collections from Eligibility Delays

20-60 extra AR days per case, equating to AUD 5k-20k monthly cash drag per dept

Manual Remittance Processing Bottlenecks

40 hours/month at AUD 50/hour = AUD 24k/year per hospital

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