Last Friday, the American Hospital Association released a 9-page report detailing the increasing financial pressures the nation’s hospitals are facing due to rising reimbursement denials and delays from payers, including Medicare Advantage and commercial plans.
Among other things, the report — which analyzed data from 1,300 hospitals across the country — found that the median hospital saw cash reserves, measured as days of cash on hand, drop 28% from 173 in January 2022 to 124 in June 2023.
Over the same time period, the report also found that Medicare Advantage claim denials jumped 55.7% and that commercial claim denials jumped 20.2% for the median hospital. The report also noted similar trends when examining how much denials have increased relative to net patient service revenue (NPSR) for the median hospital. In this regard, the report found that, for the median hospital, claim denials rose 63.3% of NPSR for Medicare Advantage plans and 20.0% of NPSR for commercial plans over the same time period.
The report also noted that, in addition to rising claim denials, hospitals also have also been subjected to wide fluctuations in accounts receivable from month to month, due in part to delays and unreliable reimbursement practices by payers.
The findings of the AHA report is consistent with the experience of Whatley Kallas, LLP’s hospital clients, who have also faced increasing reimbursement denials and delays from Medicare Advantage and commercial health plans in recent years. However, the attorneys at Whatley Kallas, LLP have successfully represented hospitals in challenging these plans’ inappropriate denials and delays.
The report is linked here.