Report: Payer requests for information are slowing reimbursement

Payers are increasingly rejecting claims through requests for information (RFI) that in total serve no purpose other than to delay reimbursement, according to “Death by a thousand requests,” a report from consulting firm Kodiak Solutions.

RFI claim denial rates as a percentage of total billed charges climbed to 3.82% in 2024 through May, up from 3.68% in 2023 and 3.51% in 2022.

And in dollar terms, the RFI denials are probably the number one issue for payers facing a hold-up in payment on its claims, said Matt Szaflarski, director of revenue cycle for Kodiak. For the first five months of 2024, $6 billion in claims were delayed among participants in Kodiak’s RCA benchmarking effort, which if prorated over a year, would be $14.4 billion, up from $11 billion in 2022.

Moreover, it’s the higher dollar claims that are being sent back the most, an indication that there may be a systematic method to the rejections, Szaflarski said.

How it works is that the payer initially denies the claim for payment based on its statement that the claim is missing needed information, but the payer doesn’t say what the problem is until after they’ve requested the medical chart and done additional research.

“It’s almost like they’re denying [generally] in order to find more time to reject you more specifically,” he said.

The end result is that payment is delayed 30 days while the payer decides it wants to deny the initial claim, and then it has 60 more days to research and pay the claim if the denial can’t be supported.