Yes. For most multi-provider practices and facilities, denial write-offs are one of the largest hidden drains on EBITDA, often erasing 3% to 5% of net patient revenue every year. Unlike a denied claim that gets reworked and paid, a write-off is money your facility has permanently given up, and it rarely shows up as a […]
Yes, for most healthcare organizations, Root Cause Denial Analysis is missing, and that gap is exactly why the same denials keep resurfacing month after month. It is the practice of tracing every denied claim back to the operational or clinical breakdown that caused it, rather than reworking the claim and moving on. Most facilities treat […]
Yes, for most multi-provider practices and facilities, medical necessity denials are one of the largest, most preventable sources of revenue leakage on the books. They happen when a payer decides that the documentation submitted doesn’t justify the service billed, even when the care itself was completely appropriate. The result is a stalled claim, a frustrated […]
Yes, for a mid-size multi-site health system, reactive claim denial management can realistically cost $5 million or more a year once you add up unrecovered write-offs, rework labor, delayed cash flow, and the staff hours spent fighting the same denials over and over. Most facilities never see the full number because it’s scattered across a […]
Yes, in most practices, refraction billing is one of the leading causes of Optometry Claim Denials, and it happens for a simple reason: CPT 92015 (refraction) is statutorily excluded from Medicare coverage, yet many practices still bill it like a routine covered service. When refraction gets bundled into a medical exam claim, sent to the […]
Appeals vs Resubmissions comes down to one question: was the claim denied because of a payer judgment call, or because of a fixable error on the claim itself? Resubmission is the right move when a claim was rejected for a correctable mistake: a typo, a missing modifier, an outdated NPI. An appeal is the right […]
Here is the fact most practices discover eighteen months too late: the majority of payer downcoding never appears as a denial at all. When UnitedHealthcare, Cigna, Anthem, or a BCBS plan downcodes a claim, one of two things happens. Either the claim is denied with CARC CO-150 — “payer deems the information submitted does not […]
Prior auth denial trends in 2026 show a 31% year-over-year increase in prior authorization denials across commercial and Medicare Advantage payers — driven by expanded PA requirement lists, AI-assisted payer adjudication, and shortened appeal windows. According to MBC’s 2026 denial management analysis across 240 specialty practices, prior auth denials now represent 34% of all first-pass […]
Denial Root Cause Analysis is a structured, data-driven discipline that traces every denied claim back to the specific process failure that created it — so your team fixes the system, not just the symptom. For healthcare organizations that want to stop bleeding revenue, this is no longer optional. Here is the problem most revenue cycle leaders […]
If you have ever visited Yellowstone National Park, you know the ground around geysers is beautiful but fragile. Beneath the surface, a pressurized system is ready to blow. This complexity and rising pressure mirror what healthcare providers face in January 2026. With the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) now in effect, the […]
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