Some facts on denials
Having a claim denied is different from having it downcoded — it means you get no money as opposed to some payment. Here are the facts on denials:
• The Health Care Financing Administration rejects 26% of all claims processed, according to Sara M. Larch, chief operating officer of University Physicians Inc., the University of Maryland School of Medicine faculty practice in Baltimore. Of those claims, 40% are never resubmitted.
• In 1999, the Medical Group Management Association found the median denial rate among its medical practice members was nearly 14%. So-called "top performing practices," however, only had a 7% denial rate.
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