Nearly one-third of inpatient and outpatient claims providers submitted to commercial payers were not paid for more than three months during the first quarter of 2023, according to a May report from public accounting, consulting and technology firm Crowe.
Crowe's revenue cycle analytics software monitors every patient financial transaction from more than 1,800 hospitals and 200,000 physicians nationwide, according to a May 17 news release from the company. Crowe uses the data gathered from its clients to monitor payer behaviors within specific markets and nationwide.
Thirty-one percent of inpatient claims and 32 percent of outpatient claims submitted to commercial payers were not paid for more than three months during the first quarter of 2023, according to the report. That is compared to 12 percent of inpatient claims and 11 percent of outpatient claims submitted to traditional Medicare that were not paid for more than three months in the first quarter of the year.
"It's hard for hospitals to rebound from the pandemic-induced downturn when their best payers are holding onto a third of their claims payments for more than 90 days," Crowe said in the report.
Commercial payers reimburse providers at a higher amount on a per-case basis compared to Medicare:
- $18,156.50 is paid by commercial payers compared to $14,887.10 paid by Medicare in average net revenue per inpatient case.
- $1,606.86 is paid by commercial payers compared with $707.30 paid by Medicare in average net revenue per outpatient case.