Healthcare Claims Management Statistics 2024 – Everything You Need to Know

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Are you looking to add Healthcare Claims Management to your arsenal of tools? Maybe for your business or personal use only, whatever it is – it’s always a good idea to know more about the most important Healthcare Claims Management statistics of 2024.

My team and I scanned the entire web and collected all the most useful Healthcare Claims Management stats on this page. You don’t need to check any other resource on the web for any Healthcare Claims Management statistics. All are here only 🙂

How much of an impact will Healthcare Claims Management have on your day-to-day? or the day-to-day of your business? Should you invest in Healthcare Claims Management? We will answer all your Healthcare Claims Management related questions here.

Please read the page carefully and don’t miss any word. 🙂

Best Healthcare Claims Management Statistics

☰ Use “CTRL+F” to quickly find statistics. There are total 162 Healthcare Claims Management Statistics on this page 🙂

Healthcare Claims Management Benefits Statistics

  • Insurers paid $3.7 in indemnity benefits (53% for temporary disability and 36% for permanent partial disability). [0]

Healthcare Claims Management Market Statistics

  • The NCCI argued for a rate reduction in 2019 of 16.8% in the voluntary market, thanks to a reduction in accidents and injuries. [0]
  • By end user, the market research organization predicted payers to account for the largest share in the global healthcare claims management market in 2018. [1]

Healthcare Claims Management Latest Statistics

  • attach_money Market Size $4bn business Number of Businesses 2,318 poll Average Industry Profit Margin x.x% Purchase this report or a membership to unlock the average company profit margin for this industry. [2]
  • Medical insurance claims adjustment 00.5% increase 0. [2]
  • It’s a 10.7% decrease from 2019 when 5,333 workers died as a result of a workplace incident. [0]
  • According to the National Safety Council, construction has reported the most number of deaths since 2012. [0]
  • It identifies the “Fatal Four” construction accidents, which accounted for 58.6% of all construction worker deaths in 2018. [0]
  • According to OSHA, if workplaces could eliminate the fatal four, they would save 591 lives every year. [0]
  • And of those reported, 33.2% were related to diseases due to viruses not elsewhere classified, which includes COVID. [0]
  • The number of serious injuries has increased from 16% to 21% between 2001 and 2017. [0]
  • 22% of serious claims were related to loading trucks and trailers. [0]
  • Arborists and tree related injuries made up 34% of the top 100 most expensive claims in this industry. [0]
  • Young workers made up 50% of serious injuries. [0]
  • Another 46% to 55% of injuries occurred in the first year on the job. [0]
  • The number of fatal injuries for this population increased from 20.4% in 2019 to 22.5% in 2020. [0]
  • Fatalities are up 21.9% since 2016 and have increased to more than 1,000 per year over the last two years. [0]
  • BLS data indicates that in 2019, Hispanic or Latino workers made up 18% of the US workforce. [0]
  • But, they accounted for 20% of workers who died on the job. [0]
  • In 2018, total losses were $13.3 billion or 77% of the calendar year premium. [0]
  • the most prolonged payouts of any state Data shows 56% of accident per year medical payments get paid more than three years after the beginning of the year of injury. [0]
  • However, the national average of claims paid after three years is 33%. [0]
  • The state takes 11 years to settle 95% of indemnity claims. [0]
  • The study found that 23% of workers said the claims process was negative or neutral with longer claims processing contributing to a poorer experience. [0]
  • The results found that engaging nurses early could knock as much as 50% off the medical bill. [0]
  • Other surprising news Lockton reviewed over 200,000 claims and found 67% of denied claims become paid claims within one year. [0]
  • And when those claims transition to paid, they cost an average of 55% more than the original claim might have. [0]
  • In the United States, the workers compensation insurance industry grew by 0.8% between 2015 and 2020. [0]
  • Between 2015 and 2018, the net premiums written grew by 2.1% despite lower premium prices during the same period. [0]
  • The average cost per $100 fell, as the WCIB predicted, to $1.77 in 2020. [0]
  • Written premium in 2020 dropped to an eight year low, down 23% from a peak of $18.1 billion in 2016. [0]
  • Between 2016 and 2018, the percentage of private sector employers paying workers comp premiums fell from 78% to 72%. [0]
  • Additionally, 67 72% of subscribers reported their premiums either fell or remained the same for the year 2018. [0]
  • The total recordable incidence rate decreased by 3.6% in 2020, despite the COVID. [0]
  • Even though 63% of those claims were recoverable, it still came with a cost of $118 per claim, or as much as $8.6 billion in appeals. [3]
  • 30% of claims are either denied, lost or ignored. [3]
  • According to an infographic created by Change Healthcare, denials represent 90% of missed revenue opportunities. [3]
  • Out of all the claims submitted, 3.8% of those claims are denied on the first submission. [3]
  • Out of all the denied claims, 65% of them are never reworked. [3]
  • 67% of healthcare providers are using an EHR. [3]
  • Hospitals write off 90% more claim denials costing up to $3.5 million. [3]
  • In 2017, health systems and hospitals wrote off 90% more claim denials as uncollectible compared to six years ago. [3]
  • This electronic transaction was supported by 85 percent of the practice management systems and clearinghouse solutions. [3]
  • However, 37 percent of medical claim payments continue to be paid by paper checks sent through email. [3]
  • 86% of mistakes made in the healthcare industry are administrative. [3]
  • A study from the Harvard Medical Practice found that 70% of errors, resulting in adverse events, were considered to be secondary to negligence, and more than 90% were judged to be preventable. [3]
  • However, 90% of claim denials can be prevented and two thirds of it is recoverable. [3]
  • Quality is also increasing as quality ratings were up 4 percent in the past year, reversing a four. [4]
  • VBA’s quality assurance program is designed to provide quality estimates within a 5% margin of error with a 95% confidence level for every 12 months of reviews. [4]
  • ** 75% of patients are looking up the cost of medical procedures online. [5]
  • 62% of patients said knowing their outof pocket expenses in advance of service impacts the likelihood of pursuing care. [5]
  • 49% of patients said having clear information on expected outof pocket costs before receiving treatment impacts their decision to use a healthcare provider. [5]
  • A new TransUnion Healthcare analysis revealed that patients experienced an 11% increase in average outof pocket costs during 2017, rising from $1,630 in Q4 2016 to $1,813 in Q4 2017. [5]
  • The analysis also revealed that in 2017, on average, 49% of patient outofpocket costs per healthcare visit were below $500; 39% were $501 $1,000; and 12% were more than $1,000. [5]
  • Total hospital revenue attributable to patient financial responsibility after insurance increased 88 percent between 2012 and 2017 Source. [5]
  • 69% have a budget process that takes more than three months from initial rollout to board presentation (the process takes more than six months for 9% of these organizations). [5]
  • 41% use rolling forecasts to complement or to replace an annual budgeting process (31% have to plans to implement rolling forecasts). [5]
  • The administrative costs associated with billing and insurance related activities as estimated to be up to 25.2% for emergency department visits. [5]
  • Associated With Physician Billing and InsuranceRelated Activities at an Academic Health Care System Patient healthcare costs – including both deductibles and outof pocket maximum payments – have increased by almost 30% percent since 2015. [5]
  • 83% of Physician Practices under five practitioners said the slow payment of high deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81%). [5]
  • 16% have a deductible under $500 19% have a deductible between $500 and $999. [5]
  • 46% have a deductible between $1,000 and $2,999 6% have a deductible between $3,000 and $3,999 6% have a deductible that is $4,000 or higher. [5]
  • 3% have a deductible under $500. [5]
  • 11% have a deductible between $500 and $999. [5]
  • 29% have a deductible between $1,000 and $2,999. [5]
  • 26% have a deductible between $3,000 and $4,999. [5]
  • 23% have a deductible of $5,000 or higher. [5]
  • 68% of patients failed to fully pay off medical bill balances in 2016, up from 53 percent in 2015, and 49 percent in 2014. [5]
  • This number is expected to climb to 95% by 2020. [5]
  • 67% of Americans are either very worried or somewhat worried about unexpected medical bills (compared to 41% who are very or somewhat worried about paying their rent or mortgage). [5]
  • Consumers are demanding more from healthcare92% of consumers want to know payment responsibility prior to a provider visit74% of consumers are confused by Explanation of Benefits and. [5]
  • medical bills73% of providers report that it takes one month or longer to collect from patients. [5]
  • The Rise of Self Pay Accounts , The Association of Credit and Collection Professionals, Collector Magazine , February 2015 30% of the average healthcare bill now comes from the patient’s pocket. [5]
  • 74 percent of healthcare providers reported an increase in patient financial responsibility in 2015 90% of patients felt it was important to know their payment responsibility upfront. [5]
  • 2015 U.S. health care spending increased 4.6 percent to reach $3.6 trillion, or $11,172 per person in 2018. [5]
  • The growth in 2018 was faster than in 2017 when health care spending increased 4.2 percent. [5]
  • The faster growth in 2018 was associated with faster growth in the net cost of health insurance, which increased 13.2 percent following growth of 4.3 percent in 2017, due primarily to the reinstatement of the health insurance tax in 2018. [5]
  • The overall share of gross domestic product related to health care spending was 17.7 percent in 2018, down from 17.9 percent in 2017. [5]
  • The insured share of the population was 90.6 percent in 2018 and 90.8 percent in 2017, as the number of uninsured increased by 1 million to 30.7 million in 2018. [5]
  • 75% of patients say that understanding their outof pocket costs improves their ability to pay for healthcare. [5]
  • 62% reported being either sometimes or always surprised by outof. [5]
  • Medicaid DSH Payments Cover 51% of Uncompensated Care Costs, RevCycle Intelligence, August 6, 2019. [5]
  • The average single premium increased 4% and the average family premium increased 5% over the past year. [5]
  • Workers’ wages increased 3.4% and inflation increased 2%. [5]
  • U.S. hospitals provided $45.9 billion in uncompensated care in 2012, representing 6.1 percent of annual hospital expenses. [5]
  • In 2018, 30.4 million persons of all ages (9.4%). [5]
  • National Health Interview Survey Early Release Program, CDC PPOs continue to be the most common plan type, enrolling 44% of covered workers in 2019. [5]
  • Thirty percent of covered workers are enrolled in a high deductible plan with a savings option , 19% in an HMO, 7% in a POS plan, and 1% in a conventional plan. [5]
  • 2019 Employer Health Benefits Survey, Kaiser Family Foundation, September 25, 2019 28% of uninsured adults either delayed or did not receive care because of cost Source. [5]
  • Patients’ outof pocket costs averaged $1,109 for an outpatient visit in 2018, up 12% compared with $990 in 2017. [5]
  • 68% of Consumers Did Not Pay Patient Financial Responsibility, RevCycle Intelligence, June 27, 2017. [5]
  • 80 percent of patients say they would prefer to pay for their care online. [5]
  • The percentage of persons under age 65 with private health insurance enrolled in a high deductible health plan increased from 43.7% in 2017 to 45.8% in 2018. [5]
  • National Health Interview Survey Early Release Program, CDC 68% of hospital bills under $500 were not paid in full Source. [5]
  • In 2020, 32% of American workers had medical debt Source. [5]
  • 32% of American workers have medical debt—and over half have defaulted on it. [5]
  • A 2013 study found that 26% of bankruptcies were due to medical debt Source. [5]
  • 11% of people surveyed with medical debt in 2017 were 27 years old Source. [5]
  • An estimated 48 million people were paying off medical debt in 2012, up from 44 million in 2010 and 37 million in 2006. [5]
  • In 2012, 41 percent of adults reported that they had medical debt or trouble paying medical bills. [5]
  • Of those who reported difficulties paying medical bills or paying off medical debt, 42 percent said they received a lower credit rating as result of unpaid medical bills. [5]
  • In 2012, 43 percent of adults, or 80 million people, said they had skipped or delayed getting needed health care or filling prescriptions because of the cost. [5]
  • More than a quarter of adults with a chronic health condition said they had skipped doses or not filled a prescription for their health condition because of the cost. [5]
  • 62% of ablebodied adults enrolled in Medicaid are either working parttime or full. [5]
  • Understanding the Intersection of Medicaid, Work, and COVID 19 Medicaid spending grew 2.9% to $613.5 billion in 2019. [5]
  • Like your typical consumer of goods, over 92% of patients want to know outof. [5]
  • In fact, 74% of patients are confused by their medical bills. [5]
  • According to studies, patients prefer this 62% of patients said knowing their outof pocket expenses in advance of service impacts the likelihood of pursuing […]. [5]
  • According to 2018 data compiled by MedData, 83 percent of physician practices reported that their top collection challenge was slow payment along with […]. [5]
  • 9% of hospital claims are initially denied. [6]
  • This equates to an average of $4.9 million per health system and a national total of $262 billion 90% of denied claims are preventable. [6]
  • Advisory Board research shows that nearly all denials are preventable, BUT, only 66% are recoverable. [6]
  • Only 35% of providers appeal denials even through 66% of denied claims are recoverable. [6]
  • The average denial rate for payers is 5. [6]
  • For Medicare and Medicaid, it’s closer to 10% 31% of healthcare providers use a manual process for managing denials. [6]
  • Each claim that is worked manually takes up to 51 additional minutes of administrative time according to the 2016 CAQH Index. [6]
  • Late submission AMA’s Administrative Burden Index calculates that healthcare providers spend up to 14% of their revenue to get paid for services. [6]
  • Our calculations suggest that, between 2007 and 2017, the average per capita cost of healthcare in many countries increased by a compound annual growth rate of more than 4 percent. [7]
  • In one survey, more than 80 percent of young people aged 12 to 25 said they would like to have a job with a meaningful purpose that allows them to develop their own ideas. [7]
  • We have found that some payers can save as much as 10 to 20 percent of medical costs if they use a digital solution such as advanced analytics to prioritize invoices for auditing or identify patients likely to have future high. [7]
  • In addition, payers can reduce their operating expenses for claims processing by up to 30 percent if robotic and automation solutions are employed to automate most of the steps. [7]
  • [7]
  • VA released Percent Change in Veteran Population by State from 2000 to 2020The Department of Veterans Affairs provides official estimates and projections of the Veteran population using the Veteran Population Projection Model. [8]
  • The “Percent Change in Veteran Population” data table shows the change in the Veteran population from 2000 to 2020 by state. [8]
  • During this period, the average decrease in the Veteran population is 25% at the state level. [8]
  • During the examined period a total of 377 claims were received by CMC, respectively 63.6% for professional liability and 36.4% for other causes. [9]
  • The CMC had expressed an opinion on 120 claims related to malpractice with the percentages of admission or rejection of liability respectively of 55% and 45%. [9]
  • In addition, almost 70% of life insurers admit that predictive analysis helps them reduce expenses and improve sales. [10]
  • These procedures are listed in the form of 5 digit codes according to the Healthcare Common Procedure Coding System. [10]
  • Statistics show that more than 91% of Americans had insurance coverage in 2020. [10]
  • As many as 78% of Americans are concerned about insurance frauds, and it’s no wonder. [10]
  • Each year, health care payers and providers in the United States spend about $496 billion on billing and insurance related costs, according to Center for American Progress estimates presented in this issue brief. [11]
  • A 2010 report by the National Academy of Medicine estimated that the United States spends about twice as much as necessary on BIR costs. [11]
  • That administrative excess currently amounts to $248 billion annually, according to CAP’s calculations. [11]
  • One study estimated that the aggregate value of challenged claims ranges from $11 billion to $54 billion annually. [11]
  • Applying the NAM’s percentages of BIR costs to recent projections of national health expenditures from the Centers for Medicare and Medicaid Services , CAP estimates that BIR costs will amount to $496 billion for 2019. [11]
  • According to CAP’s calculations, this includes $158 billion in overhead for private insurance; $56 billion for administration of public insurance programs; and $282 billion for the BIR costs of hospitals, physicians, and other care providers. [11]
  • Insurers and employers spend an estimated $4.8 billion annually to assist consumers with low health insurance literacy, according to the consulting firm Accenture. [11]
  • The NAM report estimated that excess BIR costs amount to $190 billion $245 billion in current dollars or roughly half of total BIR expenditures in a year. [11]
  • The NAM report estimated that 66 percent of BIR costs for private insurers and 50 percent of BIR costs among providers are excess. [11]
  • Based on these percentages, $248 billion of the total $496 billion BIR costs in CAP’s updated estimate are excess administrative costs. [11]
  • They found that 62 percent of the difference between the two countries was attributable to prices and intensity of care, and 38 percent was linked to administrative costs. [11]
  • Compared with Canada, the United States has 44 percent more administrative staff, and U.S. physicians dedicate about 50 percent more time on administrative tasks. [11]
  • The BIR costs for traditional Medicare and Medicaid hover around 2 percent to 5 percent, while those for private insurance is about 17 percent. [11]
  • In 2016, administration accounted for 8.3 percent of total health care expenditures in the United States the largest share among comparable nations. [11]
  • For example, administrative spending accounts for just 2.7 percent of total health care expenditures in Canada. [11]
  • Administrative expenditures account for 4.8 percent of total health care expenditures in Germany, 3.9 percent in the Netherlands, 3.8 percent in Switzerland, and 1.6 percent in Japan, according to the OECD. [11]
  • If the United States could reduce administrative costs down to Canadian levels, it would save 68 percent of current administrative expenditures; reducing to German level administrative costs would save 42 percent of current administrative expenditures. [11]
  • Relative to the professional revenue associated with each encounter studied, the emergency department visit ranked the highest, with billing costs equal to 25.2 percent of revenue. [11]
  • Inpatient visits were the lowest, at 8 percent of a general inpatient stay and 3.1 percent for inpatient surgery. [11]
  • Among other research on provider BIR costs, a 2009 study by Larry Casalino and others estimated that the cost of the time physicians spend on interactions with health plans is about $23 billion to $31 billion per year. [11]
  • In their comparison of hospital administrative costs among eight Western nations, Himmelstein and co authors found that the United States had the highest levels, at 25.3 percent of total hospital expenditures. [11]
  • They conclude that in nations where hospital administrators have minimal responsibilities for procuring financing and where the hospital reimbursement system is least complex, administrative costs can be reduced to 12 percent of expenditures. [11]
  • RAND specified administrative costs at 13 percent and 3 percent in its alternative scenarios. [11]
  • According to RAND analysis of hospital costs, Maryland hospitals have administrative costs that are 9 percent lower than the national average and not far off from the 13 percent savings. [11]
  • Despite having more than 3,000 health plans, Japan’s administrative expenditures were a stunningly low 1.6 percent of overall health care costs in 2015, one of the lowest among OECD member nations. [11]
  • The two singlepayer options they examined would result in even greater administrative savings of between 7.3 percent and 7.8 percent, depending on the rate. [11]
  • The group estimated that a third scenario, which would establish a centralized claims clearinghouse while allowing multiple payers, could generate savings equal to 3.6 percent of total expenditures. [11]
  • A recent bill proposed by Sens. Bill Cassidy and Tina Smith would direct the HHS secretary to set goals to cut “unnecessary costs and administrative burdens” throughout the health care system by 50 percent over the next 10 years. [11]
  • In a separate report, the same authors proposed additional reforms that they estimated could reduce excess administrative costs by $40 billion, or 25 percent of total health care expenditures. [11]
  • Doing so could save $7 billion in billing costs for physician and other clinical services, according to the authors’ estimates. [11]
  • We helped them achieve a 16% reduction in total loss cost without reducing service to injured workers. [12]

I know you want to use Healthcare Claims Management Software, thus we made this list of best Healthcare Claims Management Software. We also wrote about how to learn Healthcare Claims Management Software and how to install Healthcare Claims Management Software. Recently we wrote how to uninstall Healthcare Claims Management Software for newbie users. Don’t forgot to check latest Healthcare Claims Management statistics of 2024.

Reference

  1. getforesight – https://getforesight.com/workers-compensation-statistics/.
  2. revcycleintelligence – https://revcycleintelligence.com/news/healthcare-claims-management-market-to-reach-13.9b-by-2024.
  3. ibisworld – https://www.ibisworld.com/united-states/market-research-reports/medical-claims-processing-services-industry/.
  4. drcatalyst – https://www.drcatalyst.com/medical-claim-denials-appeals-statistics-that-you-want-know.
  5. va – https://www.benefits.va.gov/reports/detailed_claims_data.asp.
  6. meddata – https://www.meddata.com/blog/2017/10/26/medical-billing-statistics/.
  7. sifthealthcare – https://www.sifthealthcare.com/blog/2019-healthcare-claims-denials.
  8. mckinsey – https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/for-better-healthcare-claims-management-think-digital-first.
  9. va – https://www.va.gov/vetdata/.
  10. nih – https://pubmed.ncbi.nlm.nih.gov/31884219/.
  11. demigos – https://demigos.com/blog-post/data-analytics-in-claims-processing/.
  12. americanprogress – https://www.americanprogress.org/article/excess-administrative-costs-burden-u-s-health-care-system/.
  13. tristargroup – https://tristargroup.net/.

How Useful is Healthcare Claims Management

One of the primary benefits of healthcare claims management is its ability to streamline the process of submitting, processing, and adjudicating claims. By using technology and automation, healthcare organizations can reduce the time and effort required to manage claims, thus improving efficiency and reducing administrative burden. This, in turn, allows healthcare providers to focus more on delivering quality patient care rather than getting bogged down in paperwork and red tape.

Furthermore, effective claims management can also help healthcare organizations minimize denials and rejections from payers, which can significantly impact their bottom line. By ensuring that claims are submitted correctly the first time, healthcare providers can avoid costly delays in reimbursement and unnecessary disputes with payers. This not only improves cash flow but also enhances overall financial performance and sustainability.

Moreover, healthcare claims management plays a crucial role in ensuring compliance with regulatory requirements and industry standards. With constantly changing rules and regulations governing healthcare billing and coding, it is essential for healthcare organizations to stay up-to-date and adhere to these guidelines to avoid penalties and legal repercussions. Effective claims management can help ensure that claims are submitted in accordance with these regulations, safeguarding the organization from compliance risks.

In addition to financial and regulatory benefits, healthcare claims management also fosters transparency and accountability within healthcare organizations. By tracking claims throughout the entire revenue cycle, healthcare providers can effectively monitor and analyze their performance, identify potential areas for improvement, and make data-driven decisions to enhance operational efficiency. This level of visibility not only improves organizational performance but also helps build trust with patients and payers.

Despite the advantages of healthcare claims management, challenges still exist that can hinder its effectiveness. The complexity of healthcare billing and coding, coupled with the growing emphasis on value-based care, can create barriers to efficiently managing claims. Limited resources, outdated technology, and workforce shortages can also pose challenges for healthcare organizations looking to optimize their claims management processes.

As the healthcare landscape continues to evolve, it is essential for healthcare organizations to invest in robust claims management solutions that address these challenges and leverage technology to enhance efficiency and effectiveness. By adopting comprehensive strategies that combine automation, analytics, and best practices, healthcare providers can optimize their revenue cycle management and achieve sustainable financial performance.

In conclusion, healthcare claims management is a critical function that can significantly impact the financial health and operational efficiency of healthcare organizations. By utilizing industry best practices, leveraging technology, and prioritizing compliance and transparency, healthcare providers can maximize the benefits of claims management and navigate the complexities of the evolving healthcare landscape.

In Conclusion

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