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Lost and Found: The $2 Billion dollars missing in the healthcare system

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Medical claims management, processing claims and related cash flow for healthcare providers, is one of the largest areas of lost revenue in the U.S. healthcare system.

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. In some cases, denied claims are never recovered and written-off. Across the U.S. healthcare system, denied claims stack up to an estimated $2B in net revenue loss.

For a $1 billion health system, reducing claims denials can yield a 0.5-1 percent lift in operating margin amounting to $5- 10 million annually. That’s why Val Cina, chief revenue officer, Southwest Diagnostics, jumped at the chance to join forces with GE Healthcare and help create a new Denials IQ dashboard. “It doesn’t help to continuously spout statistics, we needed better diagnostics to help solve this problem,” said Cina.GEHealthcare_Infographic_Box4

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

And Cina didn’t need to be a software engineer to understand the complex process of medical claims and know what success looked like across the industry. “We knew when we had denials out there, but needed a way to easily see how or why they were happening, said Cina.

While Southwest Diagnostics denials rate is considerably below the industry average, at any given time they have approximately 16,000 outstanding denied claims, representing about $1.5 million in potential revenue. “I am a happy woman”, said Cina of the new software. “With Denials IQ we are seeing that research and analysis that can take a month, can now be done in a week.”

GEHealthcare_Infographic_Box2“We selected industry leaders to work alongside of us in the development of our latest release of DenialsIQ,” said Jon Zimmerman, GM, GE Healthcare Clinical Business Solutions. “In a matter of four weeks, we worked in lockstep with providers large and small to ensure that our most recent updates match their workflow and solve their biggest challenges in processing medical claim
denials.”

To help get the solution in the hands of more facilities that need it, GE Healthcare and Accenture announced a new offering this week to combine GE Healthcare’s advanced analytics solution, DenialsIQ, with Accenture’s experience and expertise in consulting.