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Leveraging Jorie AI to Address Private Payers' Tactics in Claims Denial Management: A Comprehensive Approach and Response to BECKER’S Hospital CFO Report

New White Paper!
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Volume 1, Issue 2: May 2024

Hamid A. Khan, MD
American Microsurgical Orthoplastic Society, CMO Strategia Project Management, USA


In March of 2024, BECKER’S Hospital CFO Report released an article titled ‘Claims Denials Are Costing Hospitals Nearly $20B Per Year”.1 The article was written in response to a survey conducted within the healthcare industry, as highlighted in the Premier Inc. article "Trend Alert: Private Payers Retain Profits by Refusing or Delaying Legitimate Medical Claims,". The outcome of this report suggested that hospitals and healthcare systems spend roughly $19.7 billion dollars a year to contest denied claims.

The following paper not only aims to explore the underlying challenges that pose these significant financial burdenson healthcare institutions, amounting to nearly $20 billion annually but also to offer comprehensive, rapid solutionsthat will aid in overcoming such incumbrances. By adopting a complete, fully automated Revenue Cycle Management (RCM) technology equipped with advanced predictive analytics, streamlined workflow automation, enhanced documentation accuracy, compliance optimization, and other cutting-edge features, Jorie AI bestows a transformative solution for addressing claims denial management challenges.

Through the seamless integration and implementation of this innovative technology, hospitals and healthcare institutions not only position themselves for guaranteed financial sustainability but they are also able to relieve the overwhelming burden of denial claims that are currently being placed on providers. Ultimately, this end-to-end advanced automation allows for the delivery of unrushed, high-quality patient care, all while ensuring that providers receive their due compensation promptly and equitably.

Key Words: Revenue Cycle Management, Medical Claims, Medical Billing, Claims Denials, Medical Reimbursement, Adjudication, Jorie AI

Abbreviations: Revenue Cycle Management (RCM), Artificial Intelligence (AI), Electronic Health Record (EHR), Ambulatory Surgical Center (ASC), American Medical Association (AMA)

Figure 1: Percentage of Claims Initially Denied, By Payer Type

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