Is it Possible to Get Your Denial Rates Under 5%?

Is it Possible to Get Your Denial Rates Under 5%?

What are normal denial rates in San Diego and the Los Angeles area? Claim denial rates from health insurance companies vary from practice to practice, but some experience upwards of 30% denials of total claims! That’s a pretty penny. We know, however, that top-performing practices experience rates below 5%. Let’s talk about how to ensure that more of your claims get reimbursed so that you can get your rates down.

 On one end of the spectrum some medical practices are experiencing denial rates of 30% of their total claims, yet the percentage of other practices experiencing denials of 10% or 20% are also stunning. The industry average at this point is something between a 5% and 10% denial rate, but getting that rate below 5% should be your practice goal.

 With so many responsibilities and priorities to juggle, practice managers often feel overwhelmed as their profits get smaller and smaller and that red line gets bigger and bigger.

Automated processes can help ensure your practice has lower denial rates and healthy cash flow.

With evolving health care initiatives and government requirements like Meaningful Use and the transition ICD-10 codes, small medical practices like yours need expert knowledge as well as tools and they need time to get both of these pieces in line—however, time for many groups, not to mention lack of resources to vet, hire, and train staff to do this work is extremely limited.

 These are just a few reasons why more and more small and mid-sized medical practices are turning to groups like SAVI for denial management systems to help them understand more about claims reimbursement and then automate them to ensure lower denial rates and a healthy cash flow.

Making a Denial Rate Calculation

 If you’re not sure what your practice’s denial rate is, there is a simple way to calculate it. The AAFP provides this sample calculation and short video to show you exactly how to figure out where your practice stands:

(Total of Claims Denied/Total of Claims Submitted)

  • Total claims denied: $10,000
  • Total claims submitted: $100,000
  • Time period: 3 months
  • $10,000/$100,000
  • 0.10
  • Denial rate for the quarter: 10%

 While this is just at the top end of the industry average, again, your practice goal is to get your number below 5%. We are ready to help you do that!

SAVI’s mission is to help your practice, not matter how small, collect more money faster and increase your practice revenue on a monthly basis. Our strong workflow process includes getting the right information to the insurer the first time, correcting denials within five days, keeping close track of all claims and documenting successes and failures.

The SAVI Group works closely with all types of healthcare practices – from solo practices to large, multispecialty practices – located throughout Southern California, in Los Angeles, Anaheim, Orange, Irvine, San Diego and other communities.

For medical billing services you can count on, call SAVI Group at 714.648.0977 or use our Request a Free Assessment link to schedule a complimentary consultation.