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Multi-Institutional Analysis of Insurance Denial Patterns Within Rhinology.

Tyler A Janz1, Najm S Khan2, Aatin K Dhanda2

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.

American Journal of Rhinology & Allergy
|March 28, 2024
PubMed
Summary
This summary is machine-generated.

Insurance denials for rhinological procedures average 2-3%, with nasal endoscopy and debridement incurring the highest costs. Practices must monitor reimbursement changes to mitigate revenue loss.

Keywords:
allergyendoscopyhealth claimsimmunologyinsuranceinsurance denialpractice managementprior authorizationrevenuerhinology

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Area of Science:

  • Otolaryngology
  • Health Services Research
  • Healthcare Finance

Background:

  • Insurance approval is crucial in US healthcare.
  • Claim denials can cause significant revenue loss (3-5%).

Purpose of the Study:

  • To analyze trends in insurance claim denials for rhinological procedures.
  • To identify procedures with the highest denial rates and financial impact.

Main Methods:

  • Retrospective analysis of deidentified financial data from 3 institutions (Jan 2021 - June 2023).
  • Data queried for rhinological and non-rhinological procedures using CPT codes.
  • Calculated cumulative insurance denials and write-offs, stratified by procedure and payer type.

Main Results:

  • A total of 102,984 procedures were reviewed, with final denial rates ranging from 2.2% to 2.9%.
  • Nasal endoscopy, nasal debridement/polypectomy, and intranasal lesion destruction had the highest write-off amounts.
  • Commercial insurance payers showed higher write-off percentages compared to Medicare/Medicaid.

Conclusions:

  • Rhinology procedure denial rates fall between 2% and 3%.
  • Nasal endoscopy and debridement are among the most costly procedures due to denials.
  • Rhinology practices need to stay informed about insurance reimbursement policies to manage financial impacts.