Healthcare Denial Management Services
Are frequent claim denials impacting your revenue? MedCloudMD’s denial management services help identify the root causes, file appeals, and prevent future rejections.
Work with our experts to improve claim approvals, resolve denials quickly, and ensure timely reimbursements keeping your practice financially healthy and compliant.
Key Performance Metrics for Denial Management
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< 30
97%
12–18%
99%
98%
Average Days in AR
Collection Ratios
Revenue Improvement
First Pass Ratio
Clean Claims Accuracy
Denial Management Services in Healthcare
Effective denial management is a critical part of healthcare revenue cycle management. Without it, practices risk losing revenue on up to 1 in 5 claims.
At MedCloudMD, our structured denial management workflow provides full transparency at every stage. From identifying denials to implementing preventive strategies, these six steps form the foundation of our results-driven process.
Denial Analysis & Reporting
Our team analyzes every denial code to uncover the root causes. We identify trends and recurring issues, compile detailed reports, and share actionable insights with your practice to prevent future denials and improve overall claim success rates.
Payer Compliance for Denied Claims
Many claim denials occur due to non-compliance with insurance rules or coding errors. Our experts ensure that claims are corrected and resubmitted according to payer regulations, contracts, and coding standards to secure proper reimbursements.
Appeals Management Services
If a claim is unjustly denied, our team handles the entire appeals process. We gather all necessary documentation EOBs, pre-authorization letters, original bills and submit appeals to recover the reimbursement you rightfully deserve.
A/R Recovery Services
From investigating denied or unpaid claims to following up on resubmissions, our accounts receivable recovery services maximize reimbursements. We handle everything from identifying unpaid claims to negotiating payment disputes so your cash flow stays consistent.
Claims Rework & Resubmission
Denied claims are carefully reviewed, errors are corrected, and missing documentation is added. We then resubmit claims accurately to the payer, increasing your chances of successful reimbursement and reducing write-offs.
We perform internal audits to identify denial patterns and recommend strategies to prevent future denials. By implementing best practices, we help your practice improve the first-pass clean claims rate, optimize revenue, and maintain long-term compliance.
Policy & Procedure Development
Get in Touch with Us for Cost-Effective Denial Management
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Our Denial Management Process & Workflow
Effective denial management is essential to healthcare revenue cycle success at MedCloudMD, our six-step workflow helps identify, resolve, and prevent claim denials to protect your revenue.
Identifying the Root Cause
The first step is reviewing the denial letter and its code to determine why the payer rejected the claim. Understanding the root cause allows us to address the issue quickly and accurately.
Verifying & Correcting Information
If the denial resulted from incorrect or missing information, we verify patient and claim details, cross-check documentation, and correct any discrepancies to ensure clean claim submissions.
Gathering Supporting Documentation
For denials caused by insufficient documentation, we collect the required medical records, authorizations, or other supporting documents from the provider and attach them to the corrected claim for resubmission.
Filing Appeals for Denied Claims
When claims are unjustly denied, our team prepares and files appeals using all necessary evidence, such as EOBs and medical necessity letters, to reverse the denial and secure rightful reimbursements.
Tracking Progress & Follow-Ups
After resubmission or appeal, we actively track each claim’s status and follow up with payers. Some claims are resolved in 48 hours, while others may take longer but we ensure nothing falls through the cracks.
Implementing Denial Prevention Strategies
Finally, we perform detailed audits and devise strategies to prevent future denials. This includes staff training, process automation, and policy updates to maintain a high first-pass clean claims rate and improve overall revenue performance.
24/7 Support Across All Specialties
We provide unparalleled, round-the-clock support to every specialty, including orthopedics, pediatrics, OB-GYNs, and more. Our customer representatives are always available on the call to address your issues. Whether you have a complex problem or a simple query, talk to us today to get the help you need to manage your AR recovery.
Cardiology
Orthopedics
Urology
Nephrology
Oncology
Radiology
OB/GYN
Behavioral Health
Neurology
Pediatrics
Anesthesiology
Gastrology
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Get in Touch with a Denial Management Specialist
Let a MedCloudMD denial management specialist handle your denied claims! Our certified experts use proven strategies to reverse denials, recover lost revenue, and prevent future claim rejections. Reach out today and start protecting your practice’s cash flow.
FAQs
What is denial management in RCM?
Denial management is a key part of revenue cycle management (RCM). It involves identifying, investigating, analyzing, resolving, and preventing claim denials. Since denials account for a significant portion of lost revenue, effective denial management helps healthcare providers maximize cash flow and improve financial performance.
What are denial codes in medical billing?
Denial codes are standardized alphanumeric identifiers used by insurance companies to explain why a claim was denied. Examples include:
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CO 4 – missing modifier
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CO 16 – missing information
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CO 18 – duplicate claim
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PR 204 – service not covered under the plan
These codes guide providers in correcting and resubmitting claims.
What is an example of a soft denial?
A soft denial occurs when a claim is denied due to missing or incorrect information. For example, codes like CO 4, CO 11, or CO 16 indicate errors that can be corrected. Once fixed, the claim can be resubmitted for proper reimbursement.
What is denial management in A/R follow-up?
Denial management teams work closely with Accounts Receivable (A/R) follow-up teams to track unpaid claims. The A/R team monitors claim recovery timelines, while denial specialists investigate denials, resubmit claims, or file appeals. Together, they recover revenue faster and optimize practice cash flow.
What are the two types of denials?
Claim denials fall into two categories:
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Hard denials: Cannot be reversed; the payment is written off, resulting in revenue loss.
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Soft denials: Can be corrected, resubmitted, or appealed, giving the provider a chance to collect the payment.
What is an example of a hard denial?
Hard denials occur when a claim cannot be reversed. For instance, claims may be denied because the provider was out-of-network (PR 242), the service isn’t covered (CO 96), or the claim was submitted after the deadline (CO 29). These typically cannot be appealed.