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Revolutionizing Denials Management: Unlocking Real ROI for Healthcare Organizations

In today’s healthcare landscape, financial stability is more fragile than ever. With labor shortages, rising operational costs, and an increase in claim denials, healthcare organizations are grappling to maintain profitability. The key challenge? The volume, complexity, and cost of handling denied claims is at an all-time high. Now more than ever, organizations need to rethink their approach to denials management and redefine what ROI really looks like.

Surge in Denials: What's Behind the Spike?

Over the past few years, claim denials have escalated across the healthcare industry, primarily due to more stringent payer requirements. From an increase in prior authorization requests to rapidly changing payer policies, providers are under intense pressure. A recent survey revealed that 38% of healthcare providers report denial rates of 10% or higher, and many are seeing rates climb above 15%. These figures indicate a major shift from the historic norm of 10% denials, which many organizations once considered acceptable.

One major driver of this surge is the growing burden of prior authorizations. As per the AMA reports average physician processes 43 prior authorizations each week, with > 25% of them being denied. The financial toll is substantial, with healthcare organizations spending an average of $181 per claim just to rework or appeal a denial. Given the rising cost of rework and the complexity of denials, healthcare providers face a serious challenge in maintaining operational efficiency and financial health. In addition to increasing denials, labor costs remain a persistent issue while availability of skilled resource gap expected to increase significantly by 2028.

The Danger of Settling for Mediocre Metrics

Many healthcare organizations still rely on outdated benchmarks to measure the success of their denials management efforts. While these traditional metrics may have been effective in the past, they can now lead to missed revenue opportunities and operational inefficiencies. A denial rate of 10% once signified optimal performance, but with increasing rejection rates, continuing to use this outdated benchmark as a standard may do more harm than good.

Furthermore, focusing only on high-dollar claims means smaller denials often go unaddressed. These "small" amounts, which many providers overlook, can represent up to 2-5% of total revenue—funds that can add up significantly over time. By ignoring these small balances, organizations are missing out on a critical revenue stream that could help improve financial performance.

Potential Strategies to Tackle Denials and Maximize Financial Returns

To successfully manage denials in today’s complex healthcare environment, organizations need a new and more comprehensive approach. The key is to implement strategies that not only reduce the volume of denials but also improve recovery rates and optimize operational costs. Here are three core strategies to consider:

• Harness the Power of Advanced Analytics and AI
  Leveraging data analytics and artificial intelligence is no longer optional. These technologies can help identify trends in denied claims, enabling healthcare providers to prioritize the most impactful denials.

• Inhouse Operations: Focus on Strategic and High-Value Activities
  The inhouse denials management team should be strategically utilized to handle tasks that are complex, sensitive, or require deep institutional knowledge — areas that cannot easily be outsourced. These may include working closely with clinical teams, managing appeals that require provider-specific documentation, addressing high-dollar or high-risk denials, and refining upstream processes to prevent future denials. By focusing internal resources on strategic activities and leveraging external partners for high-volume, repetitive tasks, organizations can maximize both efficiency and financial outcomes.

• Outsource to Global Service Partner for Efficiency
  With labor costs continuing to rise and workforce shortages on the horizon, outsourcing certain aspects of denials management to global service providers like RevSync Healthcare can offer a strategic solution. By doing so, organizations can lower operational costs and alleviate pressure on internal teams, allowing them to focus on high-priority denials and more complex issues. A well-managed outsourcing strategy can result in improved revenue recovery and reduced operating costs.

The Path Forward

As the healthcare industry continues to face rising denial rates and increased operational pressures, now is the time for organizations to reassess their denials management strategies. By embracing advanced analytics, exploring outsourcing solutions, and evolving performance benchmarks, healthcare providers can redefine their ROI and improve both revenue recovery and operational efficiency.

Want to dive deeper into these strategies and understand how to transform your denials management approach? Download our in-depth white paper, Redefining ROI in Denials Management. In this resource, we offer actionable insights and a step-by-step guide to help your organization combat rising denial rates, streamline operations, and ultimately drive financial stability and growth.

Author: RevSync Healthcare

info@revsynchealthcare.com

Solving Insurance Verification & Prior Authorization Challenges with Extended Teams

In today’s complex healthcare environment, hospitals, health systems, and provider groups face mounting challenges in managing insurance verification and prior authorization. From staffing shortages to rising operational costs, these critical front-end tasks often become bottlenecks that slow down the revenue cycle, delay patient care, and increase the risk of denials.

At RevSync Healthcare, we understand these challenges firsthand. As an extended global team for U.S. hospitals, health systems, and provider organizations, we specialize in streamlining RCM processes—particularly those high-touch areas like eligibility checks and prior authorizations.

The Cost of Inefficiency: Industry data shows that providers spend an average of 24–25 minutes and $14 per manual insurance verification or authorization request. Cumulatively, that adds up to billions in avoidable administrative spend. On top of that:

• Up to 15% of claims are denied initially, with many stemming from missing authorizations or eligibility errors.

• 73% of providers report an increase in denials, while 67% face slower reimbursements.

When your internal teams are stretched thin, even simple verifications can lead to missed deadlines, delayed care, or denied claims—all of which directly impact your bottom line.

How RevSync Healthcare Helps

RevSync Healthcare serves as an extended offshore partner to your internal revenue cycle team. With operations in India and the Philippines, our trained professionals deliver 24/7 support for high-volume insurance verification and prior authorization workflows. Here’s how we help:

✅ 24/7 Global Coverage

With teams working across time zones, your verification tasks don’t stop at 5 PM. We handle overnight and weekend workloads so your U.S. staff returns to completed verifications—ready to schedule care faster.

✅ Scalable Staffing

Whether you're ramping up for open enrollment season or dealing with unexpected attrition, our offshore model flexes with your needs—without the overhead of hiring and training.

✅ Lower Operating Costs

By leveraging global talent, we reduce the per-transaction cost of insurance verification and authorization while increasing efficiency and speed—without compromising on quality.

✅ Trained RCM Experts

Our offshore professionals are HIPAA-trained and experienced in payer rules, EHR platforms, and compliance. You get access to a specialized team without the burden of recruiting or training internally.

✅ Accuracy & Compliance

With stringent quality control and secure data protocols, RevSync delivers high accuracy rates while maintaining full compliance with U.S. privacy and security standards.

Why RevSync Healthcare?

At RevSync Healthcare, we don’t replace your team—we extend it. Our model allows you to maintain control, improve performance, and lower cost-to-collect with a trusted offshore backbone supporting your success.

If your organization is struggling with delays, denials, or high verification costs, it's time to consider a better model. Let RevSync Healthcare be your extended team—helping you move faster, reduce costs, and keep the revenue cycle flowing.

Contact us to learn how our global RCM solutions can support your operational goals.