Abstract：
BACKGROUND: Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue.
OBJECTIVE: Examine the trends in insurance denials for rhinological procedures.
METHODS: A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials.
RESULTS: A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid.
CONCLUSIONS: Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.
OBJECTIVE: Examine the trends in insurance denials for rhinological procedures.
METHODS: A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials.
RESULTS: A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid.
CONCLUSIONS: Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.
摘要：
背景：获得保险批准是美国医疗保健的必要组成部分，据估计，拒绝这些索赔会导致收入损失3％至5％。
目的：检查鼻部手术保险否认的趋势。
方法：对从2021年1月1日至2023年6月30日由3个机构的参与医生治疗的患者的未识别财务数据进行回顾性审查。通过CPT代码查询数据的鼻学和非鼻学程序。累积保险拒绝按程序和保险类型进行计算和分层。注销是与最终拒绝相关的美元金额。
结果：对102,984个程序和访问的样本显示，各机构的最终拒绝率在2.2％至2.9％之间（p=.72）。最终注销的前三个鼻学程序是：鼻内窥镜检查（16.24％，$111,836.87），鼻清创术或息肉切除术(6.48%，$79,457.51），和鼻内病变的破坏（2.11%，56,932.20美元）。与Medicare或Medicaid相比，每种程序的注销百分比在商业保险付款人中最高。
结论：鼻学手术的最终否认率介于2%和3%之间。诸如鼻内窥镜检查和鼻清创术之类的常见程序是最高的注销程序。拒绝保险可能会导致明显的收入损失。鼻学实践必须继续了解保险报销对其实践的变化和影响。
目的：检查鼻部手术保险否认的趋势。
方法：对从2021年1月1日至2023年6月30日由3个机构的参与医生治疗的患者的未识别财务数据进行回顾性审查。通过CPT代码查询数据的鼻学和非鼻学程序。累积保险拒绝按程序和保险类型进行计算和分层。注销是与最终拒绝相关的美元金额。
结果：对102,984个程序和访问的样本显示，各机构的最终拒绝率在2.2％至2.9％之间（p=.72）。最终注销的前三个鼻学程序是：鼻内窥镜检查（16.24％，$111,836.87），鼻清创术或息肉切除术(6.48%，$79,457.51），和鼻内病变的破坏（2.11%，56,932.20美元）。与Medicare或Medicaid相比，每种程序的注销百分比在商业保险付款人中最高。
结论：鼻学手术的最终否认率介于2%和3%之间。诸如鼻内窥镜检查和鼻清创术之类的常见程序是最高的注销程序。拒绝保险可能会导致明显的收入损失。鼻学实践必须继续了解保险报销对其实践的变化和影响。
