Multi-Institutional Analysis of Insurance Denial Patterns Within Rhinology.

IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY American Journal of Rhinology & Allergy Pub Date : 2024-07-01 Epub Date: 2024-03-28 DOI:10.1177/19458924241242856
Tyler A Janz, Najm S Khan, Aatin K Dhanda, Masayoshi Takashima, Arthur W Wu, Dennis M Tang, Thomas S Higgins, Murugappan Ramanathan, Omar G Ahmed
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Abstract

Background: Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue.

Objective: Examine the trends in insurance denials for rhinological procedures.

Methods: A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials.

Results: A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid.

Conclusion: Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.

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鼻科拒绝保险模式的多机构分析。
背景:在美国,获得保险批准是医疗保健的必要组成部分,据估计,拒绝保险理赔会导致 3% 至 5% 的收入损失:研究鼻科手术保险拒赔的趋势:方法:对 3 家机构的参与医生在 2021 年 1 月 1 日至 2023 年 6 月 30 日期间治疗的患者的去身份财务数据进行回顾性审查。通过 CPT 编码查询鼻科和非鼻科手术数据。计算了累计保险拒付率,并按手术和保险类型进行了分层。注销是指与最终拒付相关的金额:在 102,984 例手术和就诊样本中,各机构的最终拒付率介于 2.2% 和 2.9% 之间(p = .72)。最终核销率最高的三种鼻科手术分别是:鼻内窥镜检查(16.24%,111836.87 美元)、鼻腔清创术或息肉切除术(6.48%,79457.51 美元)和鼻内病变破坏(2.11%,56932.20 美元)。与医疗保险或医疗补助相比,商业保险支付者对每项手术的核销比例最高:结论:鼻科手术的最终拒付率介于 2% 与 3% 之间。鼻内窥镜检查和鼻腔清创术等常见手术是注销率最高的手术之一。保险拒付会导致显著的收入损失。鼻科诊所必须继续了解保险报销的变化和对诊所的影响。
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来源期刊
CiteScore
5.60
自引率
11.50%
发文量
82
审稿时长
4-8 weeks
期刊介绍: The American Journal of Rhinology & Allergy is a peer-reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials, and review articles.
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