{"id":15305,"date":"2022-03-31T18:14:15","date_gmt":"2022-03-31T18:14:15","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15305"},"modified":"2025-10-22T14:00:52","modified_gmt":"2025-10-22T14:00:52","slug":"reducing-denied-claim-percentage","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/reducing-denied-claim-percentage\/","title":{"rendered":"Reducing Denied Claim Percentage"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">When you submit a claim to any insurance carrier, it will either get paid, fully or partially, or it might get rejected or it might get denied. Most of the time, providers get confused between claim rejection and claim denial. When a claim is rejected, it generally means details mentioned in the claim are either incomplete or inaccurate. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">So, you need to provide accurate and\/or complete patient and insurance details for a claim to get processed. But when your claims got denied, means the payer has processed your claim and denied the payment.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"> <strong>Medical Billers and Coders (MBC)<\/strong> is a leading revenue cycle company providing complete medical billing and coding services. In this article, we shared some basic tips for reducing denied claim percentages.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Reducing Denied Claim Percentage<\/span><\/h2>\n<h3><span style=\"font-weight: 400;\">Track Every Claim<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The easiest way to reduce your claim denial is to account for every submitted claim accurately. Most practices, focus only on submitting claims as quickly as possible and won\u2019t track them. You need to track every single submitted claim, to classify claims as paid, denied, rejected, in process. As per market standards, it\u2019s quite normal to have around 10 percent as denied claims. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">It&#8217;s normal because you might be billing new payers, new services, or patients might have switched insurances. Make sure that your denial percentage won\u2019t climb more than 10 percent at any time. If you are not tracking the claim, start taking follow up with all payers for claims submitted in the last 9 to 10 months.<\/span><\/p>\n<p><a href=\"tel:888-357-3226\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-21372\" src=\"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2024\/11\/Legacy-AR-MBC.jpg\" alt=\"Legacy AR - MBC\" width=\"1492\" height=\"427\" \/><\/a><\/p>\n<h3><span style=\"font-weight: 400;\">Carefully Read ERAs\/EOBs<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Insurance carriers will convey claim payment status using <a href=\"https:\/\/www.cms.gov\/priorities\/key-initiatives\/burden-reduction\/administrative-simplification\/transactions\/health-care-payment-remittance-advice-electronic-funds-transfer#:~:text=An%20electronic%20remittance%20advice%2C%20or,Secondary%20payers\">Electronic Remittance Advice (ERAs) or Explanation of Benefits (EOBs)<\/a>. Carefully read every line item of remittance advice and can categorize claims as paid, unpaid, and denied. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">You need a billing expert who understands every denial reason and remark code and reworks and submit the claim with corrected or\/and additional information. It will ensure, you are not missing any claims and all claims needed attention are corrected and resubmitted on time.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Find the Most Common Denials<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">When you start tracking every claim, you will find patterns in a claim denial, whether it would be patient-wise, payer-wise, or procedure-code-wise. After finding the most common reason for your claim denials, well-tested resolutions will help and you can correct claims without much research. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some of the common denial reasons are patient\u2019s coverage expired, prior authorization missing, diagnosis codes inconsistent with the procedure, timely filling limit expired. Once you realize the most common denial reasons, modify your billing process to avoid such denials in the future. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">For example, once you discovered the need for prior authorization for some procedure codes\/ patients then update your billing activities so that you will undertake prior authorizations a few days prior patient\u2019s visit.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Appeal Every Denial<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Stop leaving revenue on the table, appeal every denial. If unsure, call the insurance rep and check what additional documentation is required. Examine every denial to see if there&#8217;s cause to appeal, if so, then move forward. Just review the denial, appeal the denial, keep your denial letter concise and factual. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Many billing software also offer, a scrubbing feature, which will help you to predict claim denial or rejection, before submitting the claim.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Benefits Verification for Every Visit<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Doing eligibility and benefits verification for every patient visit is a must for reducing denials. Benefits\/insurance coverage report will help you to understand insurance coverage, patient responsibility, or the need for prior authorization. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">There is some billing software that provides the feature of checking benefits reports, or you can check it through the provider portal or you can simply call an insurance rep and request them to send you a benefits report. There is a standard script that you can keep as a reference while calling the insurance rep.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ensuring that all your submitted claims get paid, will ensure a steady flow of revenue for your practice. Above mentioned tips will help you in reducing denied claim percentage and increasing paid claim percentage. If you are struggling to receive accurate reimbursement for delivered services from patients and payers then we can assist you. <\/span><\/p>\n<p><a href=\"https:\/\/www.medicalbillersandcoders.com\/\"><b>Medical Billers and Coders (MBC)<\/b><\/a><span style=\"font-weight: 400;\"> is a leading revenue cycle company providing complete medical billing and coding services. We can assist you in reducing the denial percentage and increasing your insurance collections. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">To learn more about our billing and coding services, contact us at <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a>\/ <a href=\"tel:888-357-3226\">888-357-3226<\/a>.<\/span><\/p>\n<h2>FAQs<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1761141585509\"><strong class=\"schema-faq-question\">1. What is the difference between a rejected and a denied claim?<\/strong> <p class=\"schema-faq-answer\">A rejected claim is due to incomplete or inaccurate details, while a denied claim means the insurance carrier has processed it and refused payment.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1761141597239\"><strong class=\"schema-faq-question\">2. How can I reduce the percentage of denied claims in my practice?<\/strong> <p class=\"schema-faq-answer\">Track every claim, carefully read Electronic Remittance Advices (ERAs) and Explanation of Benefits (EOBs), and identify common denial reasons to prevent them in the future.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1761141608067\"><strong class=\"schema-faq-question\">3. Why is tracking every claim submission important?<\/strong> <p class=\"schema-faq-answer\">Tracking ensures you identify claims that are paid, denied, or rejected and allows you to follow up on unpaid claims, helping to keep your denial rate below 10%.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1761141618300\"><strong class=\"schema-faq-question\">4. How can I identify the most common reasons for claim denials?<\/strong> <p class=\"schema-faq-answer\">By tracking claims over time, you can spot patterns such as expired coverage, missing prior authorization, or incorrect diagnosis codes, and take steps to address them.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1761141628151\"><strong class=\"schema-faq-question\">5. What should I do if a claim is denied?<\/strong> <p class=\"schema-faq-answer\">Always appeal a denial, review the reasons carefully, gather any necessary documentation, and submit the appeal to maximize your chances of getting the claim paid.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>When you submit a claim to any insurance carrier, it will either get paid, fully or partially, or it might get rejected or it might get denied. Most of the time, providers get confused between claim rejection and claim denial. When a claim is rejected, it generally means details mentioned in the claim are either [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":15306,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[5145,5144,3326,3327,2855,20,12,3329],"class_list":["post-15305","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-claim-rejection","tag-denied-claim","tag-denied-claim-percentage","tag-denied-claim-percentages","tag-denied-claims","tag-medical-billing-and-coding","tag-medical-billing-services-2","tag-reducing-denied-claim-percentage"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Reducing Denied Claim Percentages: Tips and Insights<\/title>\n<meta name=\"description\" content=\"Learn how to reduce denied claim percentages with these helpful tips. 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