Researchers who examined claim denial rates for various payers estimated the healthcare sector deals with $11 billion in challenged revenue each year, but the number could be as high as $54 billion.
They studied rates of claim denials for private insurers, Medicare and Medicaid for physicians in five specialties: cardiology, internal and family medicine, OB/GYN, orthopedics and pediatrics.
Here are five findings from the study, which was published on Health Affairs.
1. Researchers determined fee-for-service Medicaid is the most challenging type of insurer to bill, with a claim denial rate 17.8 percentage points higher than the claim denial rate for fee-for-service Medicare.
2. The claim denial rate for Medicaid managed care was 6 percentage points higher than the rate for fee-for-service Medicare.
3. The denial rate for private insurance was comparable to the denial rate of Medicare Advantage.
4. The mean claims denial rate was 22 percent for traditional fee-for-service Medicaid; 10 percent for insurer-run Medicaid; 3 percent for fee-for service Medicare; and 4 percent for insurer-run Medicare Advantage and private insurance plans, Medscape reported.
5. "Conventional wisdom held that it should be more challenging for doctors to bill private insurers. Yet, when it comes to Medicaid, our results show the opposite," said Joshua Gottlieb, the study's first author, in a statement to Medscape. Mr. Gottlieb is an associate professor at the Vancouver School of Economics at the University of British Columbia, Canada.