Physician Leadership Journal Peer reviewed
A Guide to Understanding Common Denial Issues
Rising clinical claim denials are straining healthcare finances, but informed clinical leaders can turn the tide by understanding denial trends and root causes to secure timely payments.
January/February 2025 Vol. 12, No. 1 pp. 11–17 DOI: 10.55834/plj.6054827417
Abstract
Continued increases in payor clinical claim denial rates place a heightened stress on a healthcare organization’s revenue cycle and financial health. Clinical leaders who have a robust understanding of the denials landscape play a unique role toward improving organizational denial rates. This article introduces basic general denial trends, discusses denials terminology and common root causes for denials in relation to the clinical revenue cycle, and offers potential solutions for getting claims paid the first time.
