Insurance Payments Continue to be Delayed Year over Year—What It Means for You

The healthcare revenue cycle is facing new challenges that can’t be ignored. Analysis of industry data reveals a concerning trend—payors took approximately 42% longer to pay in Q3 2024 compared to Q3 2023. This means cash flow disruptions, extended recovery times, and potentially significant financial impacts on your organization. Payment delays not only strains healthcare organizations but also fuels public frustration, as individuals grow increasingly discontent with the financial tactics affecting their access to timely and quality care. 

What we're seeing 

We’ve consistently seen an increase in denials over the past five years. Our data analysis highlights several critical findings that demand attention from healthcare revenue management leaders:  

42% Increase in Days to Pay: On average, payors are delaying payments by an additional 42% year over year.  

Denial Recovery Doubled in Time: The average time from denial date to overturn date has more than doubled. This alone has had a ripple effect, significantly contributing to the increase in total days to pay.  

Significant Financial Impact: Across the industry, the increased denial recovery time, coupled with longer payor processing times, is costing hospitals millions of dollars. 

Credentialing and Documentation - Major Culprits:

Credentialing-related days to pay have surged by 100%. Clinical Documentation days to pay have skyrocketed nearly 200%, suggesting systematic inefficiencies that need urgent intervention.  

If your team has noticed delays in payments or extended recovery periods, you’re not alone. But what’s noteworthy is that the trend affects the majority of hospitals —with very few exceptions. The increases have been significant, with the highest spikes for denial appeals reaching upwards of 65% year over year. These numbers are not anomalies. They underline a growing systemic issue that requires healthcare revenue cycle leaders to go beyond surface-level fixes.  

What You Can Do About It

While the challenges are formidable, taking deliberate, focused action can significantly reduce the time to pay and protect your cash flow. Here are key steps to address this pressing issue:

1. Focus on Clean Claims 

Your best defense against delayed payments starts with submitting clean claims. When you have a properly billed claim, you can expect to be paid in around three weeks.  

• Review claims thoroughly before submission
• Ensure that all relevant patient and procedure information is accurate and comprehensive

Remember, every denied claim or resubmission adds unnecessary days (and stress) to your organization. 

2. Examine Your Resource Allocation

The time it takes your department to work on recovering denials is directly impacting your pay timeline. Ask yourself these key questions: 

• How long does your team take to review and resubmit denied claims? 
• Do you have the right resources and experts in place to accelerate this process? 
• Do you have a safety net vendor in place to ensure dollars aren't missed?
• How many claims can your team handle in a day?
• How many calls does it take to collect?
• Do you have the right size team?

If your team is stretched too thin, delays are inevitable. Reallocating resources to an experienced organization like PMMC helps you focus on faster recovery and could create significant improvements. PMMC provides flexible solutions tailored to your organization's unique needs, ensuring efficient and effective payment processes. 

Key Takeaways

• Clean claims can reduce denial rates.
• Evaluate your team's current workflows and consider boosting staff or tools to help expedite recovery processes.
  
• Few teams have the resources to fully staff. It's critical you have a partner audit your processes and make sure holes are plugged. 

Keeping a pulse on these challenges ensures you stay ahead of growing trends and maintain cash flow stability. These challenges will continue to grow. It’s critical you put the proper systems in place today.