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Denials Management Services 2024
Which Firms Are Helping Overturn & Prevent Denials?
Author
Mollie Hunt
Author
Jennifer Hickenlooper
Author
Braden Taylor
Healthcare organizations continue to face challenges with getting reimbursements, due in part to large volumes of complex medical claim denials issued by payer organizations. To access expertise in managing the appeals process, many healthcare organizations are engaging denials management services firms, who utilize multidisciplinary teams (e.g., legal, clinical, coding) to review accounts and submit appeals. This report—KLAS’ first on denials management services—examines which firms consistently deliver strong execution, expected overturn rates, expertise, and partnership in denials prevention.
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Key Findings:
- Aspirion & Revecore* Provide Consistent Client Experiences by Efficiently Managing Appeals, Meeting Overturn Rate Expectations & Utilizing Legal Expertise
- R1 RCM & Xsolis* Effectively Handle Denials for Majority of Respondents, despite Some Variability in Client Experience
- Aspirion’s Denials Prevention & Revecore’s* Collaboration Lead to Deeper Strategic Partnerships; R1 RCM’s Leadership & Attention to Clients Drive Strong Relationships
- Across the Market, Firms Have Opportunity to Enhance Consistency & Depth of Reporting
*Limited data
Writer
Carlisa Cramer
Designer
Jessica Bonnett
Project Manager
Sydney Toomer
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.