Complete Guide to Reducing Claim Denials: From Eligibility to Coding!
- Denials drain revenue: Practices lose 3–5% annually to denials, and 65% of denied claims never get reworked.
- Root causes go beyond errors: Specialty practices face denials due to shifting payer rules, coding complexities, prior auth delays, and communication gaps.
- Key denial triggers: Eligibility gaps, prior authorization delays, coding errors, medical necessity conflicts, duplicate billing, late filing, and documentation shortfalls.
- Specialty-specific risks: Oncology (PAs), Orthopedics (modifiers), Dermatology (bundling), Cardiology (device billing).
- Smarter strategies: Use denial analytics, automated eligibility/PA workflows, cross-training, and real-time claim scrubbing.
- Practolytics advantage: 5M+ claims processed annually, 1400+ providers, 28+ specialties, automation tools, and certified RCM expertise.
- Bottom line: Prevention costs less than recovery—build smarter systems to stop denials before they start.
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- Denials drain revenue: Practices lose 3–5% annually to denials, and 65% of denied claims never get reworked.
- Root causes go beyond errors: Specialty practices face denials due to shifting payer rules, coding complexities, prior auth delays, and communication gaps.
- Key denial triggers: Eligibility gaps, prior authorization delays, coding errors, medical necessity conflicts, duplicate billing, late filing, and documentation shortfalls.
- Specialty-specific risks: Oncology (PAs), Orthopedics (modifiers), Dermatology (bundling), Cardiology (device billing).
- Smarter strategies: Use denial analytics, automated eligibility/PA workflows, cross-training, and real-time claim scrubbing.
- Practolytics advantage: 5M+ claims processed annually, 1400+ providers, 28+ specialties, automation tools, and certified RCM expertise.
- Bottom line: Prevention costs less than recovery—build smarter systems to stop denials before they start.