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GE Healthcare Uncovers $2 Billion of Actionable Denials for U.S. Healthcare Providers

GE | February 20, 2017

GE Healthcare Uncovers $2 Billion of Actionable Denials for U.S. Healthcare Providers

GE Healthcare has uncovered $2 billion¹ of actionable health insurance claim denials for its customers since January 2016. Of the $2 billion, approximately 30 percent of those denials result from coding issues, costing providers on average between $9 and $24 million per year. Another 19 to 22 percent of those denied claims stem from eligibility discrepancies, resulting in an average of $6 to $15 million in lost revenue. Also among the top culprits for actionable denials are issues with timely filing, prior authorization and credentials.

GE Healthcare has found that hospitals, on average, lose between 2 and 5 percent of their net patient revenue to avoidable denials. Those denials are fixable with the help of DenialsIQ^TM, an advanced analytics solution using machine learning capabilities to identify correctable denials and their cause. GE Healthcare is actively working alongside U.S. healthcare providers to reduce lost revenue and has seen significant results since launching the solution in 2016.

“In recent years, Ohio ENT and Allergy Physicians has experienced a rise in denied claims, resulting in high re-work costs with very little return,” said Rhonda Burge, CPC Billing Director, Ohio ENT and Allergy Physicians. “Since implementing DenialsIQ, we have not only identified the source of our denials, but have started recapturing revenue with new processes.”

Ohio ENT and Allergy Physicians, Ohio’s largest independent ENT and Allergy group, used DenialsIQ to help reduce coding denials by 24 percent, improving coding performance by $95k from January 2016 to December 2016. In that time, the provider has decreased its denied charges by 10 percent by working to redesign workflows and financial operations based on its insights.

“In this challenging economic environment, healthcare providers are seeking new ways to address quality, cost and access issues by looking to unique purchasing, imaging and clinical productivity solutions,” said Jon Zimmerman, General Manager of Value Based Care, GE Healthcare. “Yet in the back office, many providers are now deploying more advanced tools to address the source of unnecessary financial loss – insurance claim denials – and making significant improvements as a result.”

DenialsIQ uses powerful algorithms originally designed by GE’s Global Research Center for the company’s aviation business. Similar to online shopping software that prompts a user with product recommendations, DenialsIQ shows administrators hidden patterns and root cause factors before medical claims denials negatively impact the revenue cycle.

It is estimated that, of the one in every five claims that’s denied, it will cost a typical health system, on average, $25 per claim to re-process. For a $1 billion health system, reducing claims denials can yield a 0.5 to 1 percent lift in operating margin - amounting to $5 to 10 million annually.

About GE Healthcare

GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter - great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. For more information about GE Healthcare, visit our website at www.gehealthcare.com.

¹ Averaged across its customer base, excluding Centricity Practice Solutions