In an era of high-deductible, high-premium health plans where patients already face significant out-of-pocket expenses, inadequate revenue cycle solutions further compound the problem, leading to claim denials. These denials often turn into patient obligations, which can turn into unmanageable debts, frequently leading to collections and contributing to provider bad debt (non-payment for services provided).
Claim denial rates can reach rates as high as 20% and higher on an annual basis.1, 2 In addition, it is reported that over $10.6B was wasted in 2022 overturning claims denials.2 The result? – A lot of expense to manage getting paid, and less time on actual patient care.
The solution? Optimize transparency with claims validation. The complexity of insurance rules is understatedly complex. Navigating the billions of unique patient details, millions of conditions of code application, thousands of pages of unstructured resources all while multiplying these variables by the hundreds of payers in the marketplace that update their rules multiple times per year, you have what seems like an infinite amount of potential conditions to consider and account for when looking to prepare a claim to seek payment.
With GEO, insurance rules are deciphered, paired with computer-assisted coding guidance, all specific to the individual payer and unique attributes of the patient. This approach provides transparency as early as patient intake, to be able to identify what services require prior authorization, what rules need to be followed when delivering recommended treatments, and how to appropriately code delivered treatments and services. This is beyond computer-assisted coding. This is beyond form completion. This is beyond claims processing. This is claims validation.
Interested to learn more? Connect with GEO today.
About the GEO Solution
GEO’s software facilitates point-of-care transparency, guiding visibility to accurate documentation and coding from the outset, while on the back-end, cross-referencing insurer rules for appropriate reimbursement with medically necessary services recommended and rendered. Across the continuum, claims creation and claims determination is more accurate, individualized, and streamlined to assist with real-time transparency between providers and insurers. The mutual results are cleaner claims, reduced manual reviews, fewer errors, and ultimately more accurate and timely reimbursements. By enhancing the revenue cycle through efficiency and transparency earlier in its lifecycle, GEO enhances client revenue margins without raising costs for patients, insurers, or providers.
Addressing administrative inefficiencies in claims preparedness and processing with GEO validation isn’t just about cost-savings—it’s a critical step toward creating a more affordable, transparent, and patient-centered healthcare system.
References:
1. Justin Lo, Michelle Long, Rayna Wallace, Meghan Salaga, and Kaye Pestaina. KFF. January 27, 2025. Claims Denials and Appeals in ACA Marketplace Plans in 2023. https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/
2. Muoio, Dave. Fierce Healthcare. Mar 22, 2024. Providers ‘wasted’ $10.6B in 2022 overturning claims denials, survey finds. https://www.fiercehealthcare.com/providers/providers-wasted-106b-2022-overturning-claims-denials-survey-finds