Analysis | By John Commins | News editor for HealthLeaders.
Eight-in-10 surveyed provider execs say the rise in payer denials is ‘brazen’ and ‘intentional.’
KEY TAKEAWAYS
The survey from the Healthcare Financial Management Association found that nearly six-in-10 CFOs say payer-provider relations are worsening. The CFOs didn’t hold back, describing the high rates of payer denials and claim adjudication errors as ‘dirty tactics,’ ‘brazen’ and ‘shocking. ‘Surging denials have led 75% of respondents to add financial services staff in the past three years to manage the process. In sharp contrast, health plan executives claim payer-provider relations are strong, and they point to value-based care initiatives as evidence. About 64% of CFOs say it’s too early to tell what effect AI will have on dealings with payers, and another 29% expect AI to make matters worse. Increased payer transparency was cited by 75% of respondents as the biggest change that could strengthen their organization’s payer relationships.
Friction between health systems and payers has worsened over the past three years, a new survey finds, with 80% provider CFOs accusing the plans of “intentional or systematic efforts to increase denials.”
The report from the Healthcare Financial Management Association found that nearly six-in-10 CFOs surveyed for “Bridging the Payer-Provider Divide” described payer-provider relations as worsening.
The CFOs didn’t hold back, describing the high rates of payer denials and claim adjudication errors as “dirty tactics,” “brazen” and “shocking.” Surging denials have led 75% of respondents to add financial services staff in the past three years to manage the process.
In sharp contrast, health plan executives reviewing the findings claim payer-provider relations are strong, and they point to value-based care initiatives as evidence.
So, where’s the disconnect?
“Hospitals and health plans engaged in value-based payment initiatives have had some success in developing collaborative working relationships,” says Richard L. Gundling, who leads HFMA’s content and professional practice.
“But on the fee-for-service side, the tenor of these relationships has deteriorated as providers’ frustration levels with payers’ administrative requirements and expectations have increased.”
About 64% of CFOs say it’s too early to tell what effect AI will have on dealings with payers, and another 29% expect AI to make matters worse. Increased payer transparency around payment rules and behaviors was cited by 75% of respondents as the primary change that could strengthen their organization’s payer relationships.
About 87% of CFOs say strained relations with health plans hurt care delivery and that patients often blame them instead of payers for delays and coverage denials.
The report offers ideas for building stronger payer-provider connections.
“Hospitals and health plans engaged in value-based payment initiatives have had some success in developing collaborative working relationships. But on the fee-for-service side, the tenor of these relationships has deteriorated as providers’ frustration levels with payers’ administrative requirements and expectations have increased. “Richard L. Gundling, SVP, HFMA.
