Improve Claims Management – Increase Revenue


While denials will always be a part of the medical billing process, healthcare providers with the help of their coding and billing service can significantly decrease the number of claims that go unpaid each year. By improving two facets of billing practices—prevention and recuperation—you can decrease the amount of denied claims and maximize your potential revenue.



I estimate around two-thirds of denials are recoverable. On the other hand, the root causes of those denials are preventable. From experience, Red House staff find that 9 out of 10 of them are preventable. The majority of denied claims are caused by simple errors, the most common of which include missing or incorrect information, duplicate claims, and claims not turned in on time.

  1. There are two main ways in which you can prevent denied claims.Implement strategies on the front end. When scheduling appointments, make sure to note the correct patient information so that you have it entered from the beginning. Also, utilize and update an automated claims system. Doing so will provide the correct codes and information for your claim automatically, and free of common human error.
  2. Make sure to double-check the information on the claim before submission. Even something as simple as a missing digit in a code can result in denial; go over the submissions before sending them to make sure the inputted information and codes are correct.

While prevention significantly reduces the amount of your rejected claims, it won’t rid your practice completely of denials. Mistakes slip through the cracks, and errors can happen on the end of the insurance companies. Sometimes, you have to dispute rejected claims. The fact that a claim was denied on the first submission does not mean it is permanently denied. However, most practices do not take advantage of the opportunity to resubmit denied claims. In fact, 65% of these claims are never corrected and resubmitted to insurers.


Your billing team constantly receives new claims, and in most cases, they may focus solely on these new claims. Some may have the attitude that a new claim has a better chance of compensation than a rejected claim. However, that is still valuable revenue being lost each month, and it adds up. Establishing a management system for denied claims can help you keep on top of both new and denied claims to ensure that you are getting the most for your services.

At the end of the day, you need to know that your practice brings in sufficient revenue. By preventing mistakes that lead to denials and resubmitting denied claims, you can find a revenue increase for your practice. Your billing service should be catching these errors in your practice and help you plan for improvement. If you’re interested, find out if your billers are giving you enough output. Don’t miss out on the opportunity to be compensated for your hard work!



Tyler Vogelsberg graduated with a Bachelor’s degree in English and a minor in Psychology. He spends his time editing children’s books, writing freelance, and finishing his own novel. When he’s not working, he either has his head in the clouds or in a book, or he is spending time with friends and family.



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