Denial Rates Surge as Prior Auth Rejections Plummet—What’s Next?

The landscape of healthcare revenue cycle management (RCM) is shifting dramatically as claim denials are on the rise while prior authorization rejections are decreasing. For RCM teams, this means a pressing need to adapt workflows and strategies to mitigate the financial impact of these growing denials.

What's Actually Happening

In 2024, a notable trend emerged where claim denials increased significantly, contrasting with a decline in prior authorization rejections. This shift indicates that while healthcare providers may be successfully obtaining prior authorizations for treatments and procedures, the claims themselves are facing heightened scrutiny and rejection. This discrepancy can create a confusing landscape for billing teams who must navigate the complexities of both processes to ensure revenue flow.