{Reference Type}: Journal Article
{Title}: Multi-Institutional Analysis of Insurance Denial Patterns Within Rhinology.
{Author}: Janz TA;Khan NS;Dhanda AK;Takashima M;Wu AW;Tang DM;Higgins TS;Ramanathan M;Ahmed OG;
{Journal}: Am J Rhinol Allergy
{Volume}: 38
{Issue}: 4
{Year}: 2024 Jul 28
{Factor}: 2.3
{DOI}: 10.1177/19458924241242856
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>Examine the trends in insurance denials for rhinological procedures.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.