The United States healthcare system continues to grapple with one of its most persistent challenges: denied insurance claims. These denials not only inflate the operational costs for healthcare providers but also contribute to a staggering volume of unpaid bills, complicating the financial landscape for hospitals and clinics nationwide. In this complex milieu, Hilal Atasoy, an associate professor at Rutgers Business School, has pinpointed a potent yet straightforward solution that could transform claim processing and significantly reduce denials — enhanced management of healthcare information technology.
Atasoy’s recent publication in the September issue of MIS Quarterly brings to light the intricate relationship between electronic health record (EHR) technologies and insurance claim denials. The study argues that software interoperability, or the lack thereof, plays a critical role in the accuracy and success of healthcare claim submissions. This connection, if addressed properly, holds the potential to alleviate some of the financial burdens currently plaguing the healthcare industry.
The foundation of Atasoy’s research rests on the Health Information Technology for Economic and Clinical Health Act (HITECH) introduced in 2009. The legislation aimed to accelerate the adoption of electronic health record systems across U.S. healthcare providers, promoting a digital infrastructure as a pillar for reformative change. Although this policy succeeded in increasing EHR uptake, it inadvertently triggered interoperability issues owing to a diverse array of software vendors employed by different institutions.
This diverse software environment creates significant data inconsistencies and gaps when patient information is transferred or accessed across different systems. Such lapses often result in erroneous or incomplete submissions to insurance companies, thereby increasing the likelihood of claim denials. Atasoy’s work meticulously examines how these technological disparities translate into real-world financial consequences for medical providers.
Between 2000 and 2020, an eye-opening $745 billion worth of healthcare services were rendered without compensation, with claim denials representing a substantial portion of this uncompensated care. To dissect the role of healthcare information technology in these denials, Atasoy and her colleagues utilized a large dataset comprising over 19 million anonymized patient visits collected from 48 hospitals in Maryland. This dataset included detailed records of whether initial claims were approved or denied.
By mapping these claims against patterns of EHR adoption and software sourcing strategies, the researchers unveiled compelling evidence: hospitals relying on multiple software vendors experienced higher rates of claim denial compared to those standardizing on a single vendor’s system. A seemingly modest reduction from 1.18% to 1.03% denial rate was observed when a single vendor approach was employed, but at scale, this marginal improvement translates to millions of dollars saved and substantial administrative efficiencies gained.
The study further delved into the influence of physicians’ familiarity with EHR systems across their workplaces. It found that when doctors practiced within hospitals utilizing similar EHR platforms, claim denials declined, underscoring the critical role of user proficiency in navigating software systems. Familiarity promotes accurate clinical data entry and fosters compliance with insurance payer protocols, ultimately enhancing the integrity and acceptability of submitted claims.
Atasoy and her team highlight this alignment between user experience and technological uniformity as a powerful lever in addressing claim denials. By fostering standardized and user-friendly interfaces within EHR systems, healthcare organizations can minimize data entry errors and streamline the flow of clinical information critical for claims processing. This insight marks an important paradigm shift, positioning software management not just as a tool for digitization, but as an integral component of financial stewardship in healthcare.
As healthcare costs spiral ever upwards, a multifaceted approach is necessary to stem mounting expenditure. While technology is not a panacea, Atasoy’s findings suggest targeted improvements in EHR interoperability and user interface standardization could deeply impact the rate of denied claims and reduce downstream costs. This efficiency gain could alleviate the financial strain faced by both providers and patients, whose care and wallets are often caught in the crossfire of administrative inefficiencies.
Moreover, the research carries significant implications for federal healthcare policy. It advocates for a strategic emphasis on EHR certification processes that ensure interoperability and minimize vendor variability. Strengthening regulatory oversight in this domain could enforce higher standards for software usability and data accuracy—critical factors that determine whether an insurance claim sails through or gets inexplicably rejected.
The standardization agenda extends beyond software to the very design of user interfaces and workflows, which when optimized, can propel data accuracy to new heights. “Placing greater emphasis on usability and standardization of user interfaces and layouts,” the researchers argue, “can substantially reduce the extent of errors in claim processing.” Such improvements offer tangible benefits, including fewer surprise bills for patients and more predictable revenue streams for healthcare providers.
Atasoy’s investigation also illuminates the underappreciated connection between clinician experience with EHR applications and operational costs linked to denials. Healthcare systems that invest in training physicians within standardized EHR environments are better positioned to curb these costs by reducing inaccuracies and incomplete submissions. This dimension underscores an often-overlooked facet of healthcare IT: the human-technology interface.
The broader takeaway from this comprehensive study is clear: technology adoption in healthcare must transcend mere presence to embrace integration and alignment. When systems are fragmented and users struggle with disjointed applications, the resulting data errors can cascade into significant financial losses. Conversely, harmonized EHR ecosystems empower providers to offer seamless, accurately documented care, bolstering both clinical and financial outcomes.
At a time when the U.S. healthcare system is under intense pressure to contain costs while improving care quality, leveraging technology strategically could be a game-changer. Atasoy’s work not only quantifies the economic impacts of EHR interoperability but also charts a path toward systemic improvements that benefit providers, payers, and patients alike. By addressing the root causes of denied insurance claims through smarter software management, the healthcare industry can move closer to a more efficient, equitable future.
Subject of Research: People
Article Title: The Interplay Between Healthcare Information Technologies and Denied Claims
News Publication Date: Not provided (Article Publication Date: 1-Sep-2025)
Web References: http://dx.doi.org/10.25300/MISQ/2024/17469
References: Hilal Atasoy et al., MIS Quarterly, September 2025
Keywords: Medical facilities, Health care, Health and medicine
