Insurance Claims: A Study in Denials

摘要

The study was to analyze the insurance claim denials to determine if Baptist Health System (BHS) of San Antonio, TX was increasing (declining) or decreasing (improving) their denial rates. The data were obtained from the BHS's financial systems program. The model tested to be statistically significant using the Total Denial ANOVA table. The NULL hypothesis will be rejected and the ALTERNATE hypothesis will be accepted. F=4.7 (4,115)p=.001. The BHS has decreased their Overall denial rates by approximately 50% over the last 12 months (April 2006 to March 2007) from the previous 12 months (April 2005 to March 2006). BHS also shows a positive downward trend in all the sub- study groups: facilities, denial categories and patient categories.