Report links rising claim denials to prior authorization and medical necessity
A Kodiak report found prior authorization and medical necessity denials drove nearly all of a 25% increase in revenue leakage. It suggests practices may be addressing the wrong causes and outlines four corrective steps.
A Kodiak report examined why claim denials are climbing and tied most of the growth in lost revenue to two review categories: prior authorization and medical necessity. The findings indicate that denials in these areas accounted for nearly all of a 25% rise in revenue leakage.
The report also suggests many medical practices may be targeting the wrong root causes when trying to reduce denials. It proposes four steps to correct course, though the available summary does not detail them.
If these findings hold, patients could encounter more delays or denials for care tied to prior authorization and medical necessity reviews. Clinicians and practices may spend more time and money appealing claims, potentially straining smaller organizations. Insurers might face greater scrutiny over how such reviews are applied. The broader effect may depend on whether the report's four corrective steps lead to clearer processes and fewer disputed claims.