Hospitals In Focus

Before the Change Healthcare cyberattack, hospitals were already grappling with insurers' tactics of delaying and denying payments for patient care. The cyberattack only amplified the challenges providers face—not just in delivering care, but also in getting reimbursed for that care. Despite the crisis, insurers continued to use these tactics. Now, six months later, Matt Szaflarski, a director and revenue cycle intelligence leader at Kodiak Solutions, and his team have uncovered something alarming: a surge in insurers’ initial Request for Information (RFI) claim denials.

Kodiak’s latest report, “Death By A Thousand Requests,” highlights the growing trend of payors denying initial claims due to RFIs, creating an enormous administrative burden on hospitals and providers. In 2024 alone, these tactics are projected to cost hospitals $4.6 billion. Szaflarski returns to the show to explain the impact of these denials on the hospital revenue cycle, which ultimately impacts the hospital’s ability to provide care.

In this episode, Szaflarski discusses:

• Updates on the Change Healthcare cyberattack;
• Rising trends in claim delays and denials, particularly RFI denials;
• Revenue cycle data insights;
• Medicare Advantage, the two-midnight rule, and observation stay challenges; and
• Recommendations for improving processes between insurers and providers.