In the healthcare sector, it is becoming increasingly challenging for patients to receive insurance coverage for their services; payor denials are increasing. Oftentimes, insurance companies are deciding that certain services are not “medically necessary,” making it more difficult for patients to receive access to the care they need. In fact, in 2021, almost 17 percent of in-network healthcare claims were denied—that’s almost one in every five! And combatting an insurance denial is an extreme headache, so healthcare workers and patients don’t always fight back for coverage. Why is there such a high number of payor denials and how can healthcare companies and patients combat this?On today’s episode of the RCMchat podcast by AGS Health, host Michelle Dawn Mooney speaks with Matthew Bridge, SVP, RCM Service Line and Erica Franko, SVP of Customer Success, both of AGS Health, to discuss payor denial management in healthcare.Mooney, Bridge, and Franko also discussed…The recent trend in the uptick of insurance denialsReasons why denials are up in healthcareSuggestions for management within organizations struggling with the increase in denialsAbout MattMatthew Bridge is Senior VP at AGS Health and prior to working at AGS, held leadership roles as Director and Manager at KPGM, Manager, Associate, and Analyst at Huron Consulting Group, and Analyst at Partners Healthcare. Bridge attended Curry College, where he earned a B.A. in Business Administration and Management.About EricaErica Franko is an experienced customer service professional who is currently SVP of Customer Success at AGS Health. Before working at AGS, Franko was Senior Manager Healthcare Provider Consumer Experience at Accenture, Beta User at The Fourth Floor, and Senior VP of Technology/Service Implementations and Advisory at nThrive, amongst other roles. Franko holds a B.A. in English Language and Literature/Letters from Penn State University and a Master of Public Health Administration, Health Policy and Management, from the University of Pittsburgh School of Public Health. About AGS HealthAGS Health uses AI-enhanced technology, data-driven services, and specialized support to maximize the performance of their healthcare clients’ revenue cycle to allow them to focus on the most crucial part of their business: caring for patients.

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