Independent Providers Lose $2.2M Annually in Claim Denials

NEW YORK—Tennr, a company whose platform uses artificial intelligence to automate the patient referral process, announced the release of its first Healthcare Provider Benchmark Report. Of the study’s findings, it was discovered independent health care providers lose over 10% (or $2.2 million) every year due to claim denials that inevitably happen while managing their backlog of patient referrals.

The report analyzed data from health care organizations using its platform to process tens of millions of patients, examining why insurance claims get denied and tracing those denials back to specific paperwork problems that happen early in the process. The study compared performance before and after using Tennr’s platform while adjusting for organizational differences, such as their size, types of insurance they work with, services they provide and where they’re located.

The report’s key findings included:

• Ten percent (or $2.2 million) of their revenue lost annually: Independent providers lose $2.2 million in revenue each year when intake paperwork is missing the information that insurers require to approve a patient’s treatment.
• Thirty-four percent fewer preventable denials: With Tennr, independent providers reduce their claims denial rate and recover some of the revenue that would otherwise be lost.
• Half of all referrals disappear: The health care industry faces a significant “leakage” problem where referrals simply fall through the cracks.
• Industry average: Only 54% of faxed referrals actually turn into orders or scheduled care.

“Most providers are dealing with what we call the ‘hidden loss fallacy’, where they’re pouring time and money into fixing billing issues after the fact, when the real opportunity is catching mistakes and missed patients earlier in the referral process,” said Trey Holterman, co-founder and CEO of Tennr. “Our data shows that the majority of costly claim denials are conceived during the initial referral intake process, not during billing.”

According to the study, nearly one in five claim submissions are now denied on first pass, with analysts estimating a $20 billion savings opportunity from automating the manual processes driving these errors. Even small improvements in patient processing help independent providers recover some of their losses, which reduces costly hospital admissions and improves patient access.

“When independent providers go out of business, patients feel the impact. They’re left with fewer options for care and higher costs,” Holterman said. “Our data shows that solving the referral processing problem helps independent providers grow their bottom line and patients maintain access to care.”