Healthcare Insights
Hospitals with the highest Medicare denied claims percentage
On average, just more than one-third of a hospital’s payor mix by total patient days comes from Medicare, one of the federal health insurance programs. With nearly 63 million beneficiaries, the program accounts for 10% of the federal budget.
In addition, healthcare insurance companies denying claims is on the rise due to numerous factors including rising healthcare costs.
What percentage of Medicare claims are denied on average?
The average percentage of Medicare denied inpatient claims is 6.8% and is 1.6% for denied outpatient claims. These figures as based on data from 2,680 hospitals with denied Medicare inpatient claims and 4,315 hospitals with denied Medicare outpatient claims, respectively.
This Healthcare Insight reviews data from the Definitive Healthcare HospitalView product and lists hospitals by the highest percentage of Medicare denied claims. Data in this analysis is sourced from the Centers for Medicare and Medicaid Services’ Standard Analytical Files (SAF), which represents calendar year 2022, the most recent data available. Only hospitals with at least 100 annual patient discharges and more than 10 denied Medicare claims are included.
| Rank | Definitive ID | Hospital name | Location | % Medicare inpatient claims denied | Explore dataset |
|---|---|---|---|---|---|
| 1 | 4970 | Kirby Forensic Psychiatric Center | New York, NY | 99.20% | Explore |
| 2 | 5602 | Lemuel Shattuck Hospital | Jamaica Plain, MA | 98.70% | Explore |
| 3 | 5643 | St Louis Forensic Treatment Center - South | St Louis, MO | 98.70% | Explore |
| 4 | 5021 | Pilgrim Psychiatric Center | West Brentwood, NY | 96.10% | Explore |
| 5 | 5947 | G Werber Bryan Psychiatric Hospital | Columbia, SC | 96.00% | Explore |
| 6 | 5039 | Creedmoor Psychiatric Center | Queens Village, NY | 95.90% | Explore |
| 7 | 6313 | Mid-Hudson Forensic Psychiatric Center | New Hampton, NY | 95.80% | Explore |
| 8 | 5357 | Bronx Psychiatric Center | Bronx, NY | 94.80% | Explore |
| 9 | 5974 | Buffalo Psychiatric Center | Buffalo, NY | 94.50% | Explore |
| 10 | 6370 | Manhattan Psychiatric Center | New York, NY | 94.20% | Explore |
Fig. 1. Data from Definitive Healthcare HospitalView product and sourced from the Medicare Quarterly Standard Analytic Files (SAF) for calendar year 2022. Accessed November 2023.
Which hospitals have the most inpatient Medicare claims denied?
Kirby Forensic Psychiatric Center in New York City had 99.2% of inpatient Medicare claims denied, the highest on the list. Two additional hospitals have more than 98% of inpatient Medicare claims denied – Lemuel Shattuck Hospital and St. Louis Forensic Treatment Center – South.
| Rank | Definitive ID | Hospital name | Location | % Medicare outpatient claims denied | Explore dataset |
|---|---|---|---|---|---|
| 1 | 780714 | Central Desert Behavioral Health Hospital | Albuquerque, NM | 86.40% | Explore |
| 2 | 6056 | Franciscan Childrens | Brighton, MA | 80.60% | Explore |
| 3 | 4970 | Kirby Forensic Psychiatric Center | New York, NY | 46.90% | Explore |
| 4 | 858224 | Bakersfield Behavioral Healthcare Hospital | Bakersfield, CA | 43.80% | Explore |
| 5 | 5808 | Alaska Psychiatric Institute | Anchorage, AK | 36.60% | Explore |
| 6 | 550792 | Santa Rosa Behavioral Healthcare Hospital | Santa Rosa, CA | 35.10% | Explore |
| 7 | 5688 | Walter P Reuther Psychiatric Hospital | Westland, MI | 31.80% | Explore |
| 8 | 4986 | Elgin Mental Health Center | Elgin, IL | 28.50% | Explore |
| 9 | 5918 | Pocasset Mental Health Center | Pocasset, MA | 27.10% | Explore |
| 10 | 4987 | Four County Counseling Center | Logansport, IN | 26.90% | Explore |
Fig. 1. Data from Definitive Healthcare HospitalView product and sourced from the Medicare Quarterly Standard Analytic Files (SAF) for calendar year 2022. Accessed November 2023.
Which hospitals have the most outpatient Medicare claims denied?
Central Desert Behavioral Health Hospital in Albuquerque, New Mexico had more than 86% of outpatient Medicare claims denied based on the last full calendar year of data, the highest on the list.
For both the inpatient and outpatient denied Medicare claims lists, many of the facilities are psychiatric hospitals and mental health or behavioral health medical centers. While Medicare covers mental health services under the Medicare Part A and Medicare Part B plans for inpatient and outpatient care, respectively, there may be several reasons why a Medicare claim might be denied. For example, Medicare beneficiaries have a lifetime limit of 190 days for inpatient psychiatric hospital care. If patients use up their days, claims for those stays may be denied.
Revenue cycle management companies and financial services firms might use a data point such as denied Medicare claims to best segment and target their key hospital accounts or monitor facility performance over time.
Learn more
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.
You might also be interested in...
