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Does your Billing Department Regularly Follow up Denials

April 08, 2014

Physician practices can end up losing high amount of revenue, when they do not bother to follow up claim denials. This may occur due to lack of time and resources or at times practices may also make the error of assuming that reimbursements received from health insurers are always accurate.

Recent findings by the American Medical Association (AMA) state that though error rates by private insurers have reduced; claim denials have been increasing steadily, giving practices even more of a reason to manage denials judiciously. Also with the introduction of claims-editing software into the payers claims processing systems, physician complaints about inappropriate claims denials and reductions too have gone up at AMA.

Industry Facts State:

Increasing denial rates among private insurers range from a high of 5.07% (Anthem Blue Cross Blue Shield) to 1.38% (Regence)
Even a 1% denial rate represents a considerable sum of money to a physician
Various practices denial rates can go up to 10%; which they do not appeal resulting in huge revenue losses and write offs
Statistics in 2014 reveal that up to 25%- 30% of claims submitted are denied due to errors which can be easily recognized and managed
Out of the 30% claims denied; 60% are never sent for resubmission to payers
55% of in-house billers have never appealed a denied claim

Why billers do not appeal denied claims?

Amongst the various reasons billers do not appeal denials; the most common is the need to avoid an increased administrative burden. But not doing so can prove to be even worse for a clinic especially in terms of revenue.

What is lost when practices do not appeal?

Practices not only let go of huge amount of revenue; but also an opportunity to recover overhead expenses by not following up denials. A study revealed that a practice in Chicago lost almost $91,000 for a single type of procedure over three years by avoiding appealing its claims. Moreover challenging an appeal demonstrates a practices ability to make the effort in bringing about a change in the health insurer’s business practices.

Managing medical denials-

This step is one of the most important steps towards increasing revenue for your practice, and the most effective way is by diligently submitting appeals. To substantiate this further, a practice in Chicago by appealing a single type of underpaid claim recovered $19000 within a time frame of 6 months.

Streamlining your claim appeal procedures by organizing the practice’s internal controls so that health insurer payment errors are identified; and appropriate collection efforts are made is a highly crucial step for practices to avoid unnecessary losses and increase revenue.

Follow up your denials with MBC’s claim management process

Increase your overall revenue with MBC's complete billing solution!

Measuring number of claims denied
Reviewing health insurer explanation of benefits (EOB)/remittance advice (RA)
Identifying correct reason for denial
Determining if claim needs to be written off, or is appealable, or can be billed to the patient
Procure supporting documents and develop a case based on payer guidelines
Resubmit claims and maintain a follow up log
Constantly continue to appeal inappropriately denied, delayed or partially paid claim
Hold constant claims processing and review meetings
Identify the type of claims denied in the past
Creating regular reports for analysis


MBC the largest consortium of billers and coders has been providing medical billing including denial management services across US for over a decade now; which meet national and local requirements for medical necessity and complies with commercial claims stipulations.

MBC’s billing services uses all the necessary resources and updated processes to reduce denied, rejected, or underpaid claims with the help of the following tools

MBC = Highly experienced, certified coding and billing professionals, specific to your specialty resulting in appropriate claim submission and constant follow up of denials + Increase in practice revenue

Category : Accounts Receivables / Claims Denials