Introduction
Healthcare organizations spent $40 billion on billing operations in 2024 while denial rates climbed to 11.8%. Providers tackle these denials, win over half of appeals, and then get paid for services they should have been reimbursed for initially. AI systems now prevent 30% of denials before submission and deliver ROI in 40 days. This paper examines what’s working, what it costs, and why organizations delaying implementation fall further behind each quarter.
Key Takeaways
- Denial rates hit 11.8% in 2024, up from 10.2% just years earlier
- 54% of denied claims eventually get approved after costly appeals
- Medicare Advantage denials jumped 55.7% between 2022-2023
- AI reduces denials by 10-30% within the first six months
- Organizations see positive ROI in 40 days on average
- Claims processing drops from 14 days to 2-3 days with automation