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Hospitals in Northern Plains have higher average claim denial rates, RelayHealth data show

The South Central region had the second-highest rate, according to RelayHealth Financial's Revenue Cycle Index.

Jeff Lagasse, Associate Editor

RelayHealth booth at HIMSS17RelayHealth booth at HIMSS17

Large hospitals in the Northern Plains have higher average claim denial rates than those in other geographic regions in the United States, according to RelayHealth Financial's Revenue Cycle Index.

Large hospitals, defined as having between 250 and 400 beds, in that region have an average claim denial rate of 10.58 percent, based on RelayHealth's calculations. The rate, based on data from McKesson, is quantified by expressing the original denial rate as a percentage of claims dollars that were denied in relation to the money billed on a remitted claim.

The South Central region had the second-highest rate at 8.8 percent. The other regions detailed by the index are clustered closely together. They are, in order, the Midwest at 7.89 percent; the Southern Plains at 7.72 percent; the Pacific at 7.58 percent; the Northeast at 7.21 percent; the Mountain region at 7.18 percent; and the Southeast at 7.14 percent.

[Also: Claims denials management tools offer hospitals opportunity to automate revenue cycle processes]

For medium-sized hospitals -- defined as having between 100 and 250 beds -- the South Central region had the highest average claim denial rates in the country, at 8.82 percent, with the Pacific region placing second at 7.93 percent. The others, in order, are the Southeast at 7.59 percent; the midwest at 7 percent; the Southern Plains at 6.46 percent; the Northeast at 6.35 percent; the Mountain region at 5.86 percent; and the Northern Plains at 5.61 percent.

For very large hospitals, defined as having more than 400 beds, the average claim denial rates in order from highest to lowest are the Mountain region at 11.02 percent; the Midwest at 8.54 percent; the Southern Plains at 8.37 percent; the South Central region at 8.29 percent; the Southeast at 7.97 percent; the Northeast at 7.89 percent; the Pacific region at 7.23 percent; and the Northern Plains at 6.44 percent.

Twitter: @JELagasse

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