🇺🇸United States

Delayed Payments from Claim Rejections

2 verified sources

Definition

Claims rejected during clearinghouse processing extend the time-to-cash cycle as hospitals wait for EOBs, perform reconciliations, and handle resubmissions. High denial rates slow payment posting and increase accounts receivable days. Manual follow-ups on denied claims further drag revenue realization.

Key Findings

  • Financial Impact: 50% slower ERA posting without automation
  • Frequency: Weekly
  • Root Cause: Lack of real-time denial management and automated resubmission workflows in clearinghouses

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Hospitals.

Affected Stakeholders

accounts receivable staff, billing supervisors, practice administrators

Deep Analysis (Premium)

Financial Impact

$1.5M government payer clawbacks • $100,000–$250,000 per year in delayed collections and write-offs on ED visits, plus labor costs associated with managing thousands of low-dollar denials manually and a 50% slower posting process compared to automated workflows. • $100K annual collection delays

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Current Workarounds

Accounts Receivable managers pull daily rejection and denial reports, dump them into Excel for prioritization and aging analysis, distribute work via email or printed worklists, and maintain manual trackers to ensure high-dollar accounts get reworked and resubmitted. • Contract Manager Excel contract-to-claim variance analysis • Contract Manager Excel payer rule matrices

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Methodology & Sources

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

Evidence Sources:

Related Business Risks

Claim Denials from Submission Errors

$15-30% reduction in denials translates to millions annually for mid-sized hospitals

Staff Bottlenecks in Manual Claim Rework

Reduced clean claim rates from 80% to below 95% causes ongoing capacity strain

Manual Delays and Idle Billing Resources from Charge Capture Bottlenecks

$Lost throughput equals unbilled revenue daily

Incorrect Coding Leading to Fraud and Abuse Penalties

$Hundreds of thousands per violation

Missed Charges from Incomplete Documentation and Coding Errors

$Unknown systemic; hotspots target millions annually per health system

Delayed Charge Entry Extending Revenue Cycle

$Tied to denial rates; industry avg 4-day target often missed

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