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.
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。