Denial management & prevention consulting
Denial management consulting finds out why your claims are being denied and fixes the cause upstream, so the same denials stop coming back. We break denials down by payer, reason code (CARC/RARC), procedure, provider and location, trace each pattern to the step where it starts, and put prevention workflows in place.
Signs you need help with denials
- Too many claims are getting denied, and the same reasons keep repeating
- Your team spends more time on appeals and rework than on new claims
- Prior authorization or eligibility problems are driving denials
- Medicare Advantage or commercial payers are denying more than they used to
- No one can tell you your denial rate, or which payer is the worst offender
Where denials usually start
- Front end: eligibility, benefits verification, demographics and prior authorization
- Mid cycle: coding, documentation and medical necessity
- Back end: timely filing, claim edits and payer-specific rules
- Follow-up: appeals that are never filed, or filed too late
What you get
- A denial breakdown by payer, reason code and dollar value
- Root causes traced to the workflow step where they start
- Prevention checklists and scripts for front-desk and billing staff
- An appeal prioritization list for denials still worth recovering
- Monthly denial tracking, if you want ongoing support
Common questions
What is a good claim denial rate?
Many practices aim to keep initial denials in the single digits, but the right target depends on your specialty and payer mix. The more useful question is which denials are preventable, and most are traced to front-end issues like eligibility and authorization.
Do you work the denials for us?
Our focus is fixing the process so fewer denials happen. We can prioritize the open denials worth appealing and support your team or billing company as they work them.
Can you help if we outsource billing?
Yes. An independent denial review is often how practices find out whether their billing company is catching and appealing denials.
Related services
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