One of the biggest challenges healthcare providers face today is how to reduce denials in medical billing. Denied claims can severely affect a medical practice’s financial health, causing delays in reimbursement, increased operational costs, and patient dissatisfaction. The good news? Most denials are preventable. This guide outlines five proven strategies that can help your practice minimize billing errors, streamline claim submissions, and maximize collections.
Denials can be hard (non-recoverable) or soft (potentially correctable). Common reasons include incorrect coding, missing information, lack of authorization, or untimely filing. Identifying and correcting these issues is key to improving claim acceptance rates.
- Invalid or outdated CPT and ICD-10 codes
- Duplicate claim submissions
- Lack of pre-authorization
- Services not covered under the patient’s plan
- Late submission beyond payer deadlines
- Non-credentialed providers
- Incomplete or missing documentation
Every denied claim costs your practice time and money. Reworking a single denial can cost between $25 and $118, and studies show that only 35% of denied claims are ever re-submitted.
One of the most frequent causes of denials is outdated or incorrect patient information.
Best Practices:
- Confirm insurance coverage, co-pays, and policy terms
- Collect accurate demographic details (DOB, address, etc.)
- Train front-desk staff to verify and update insurance data
Coding errors are a top reason for claim denials. Ensure your team uses the latest CPT, ICD-10, and HCPCS codes.
Best Practices:
- Employ certified medical coders or outsource to experts
- Stay updated with code changes from CMS and AMA
- Utilize AI-based coding tools for higher accuracy
- Cross-check codes for alignment with documentation
Pro Tip: Use claim scrubbers to detect coding errors pre-submission.
Lack of prior authorization is a common and costly denial reason.
Best Practices:
- Maintain an updated checklist of services needing prior authorization
- Train staff to recognize high-risk procedures requiring approval
- Track authorizations and set alerts for expiration
- Document all communication with payers
Pro Tip: Automate prior auth workflows to speed up approvals.
Timely filing is critical to avoid hard denials. Monitor every claim’s status from submission to payment.
Best Practices:
- Submit claims within 48 hours of service
- Monitor rejection reports from clearinghouses
- Track the full claim lifecycle
- Use denial management tools to analyze trends
Pro Tip: Set internal KPIs for claim submission and resolution times.
Ongoing audits and training help prevent repeat mistakes and keep your team up to date.
Best Practices:
- Audit denied and approved claims monthly
- Maintain a denial log by payer and error type
- Hold quarterly training sessions for all billing staff
- Keep the team updated on payer policy changes
Pro Tip: Use denial trends to create internal case studies for training.
By focusing on these five proven strategies, your practice can reduce denials in medical billing, enhance revenue, and improve efficiency. With the right technology, team training, and proactive processes, you can take control of your revenue cycle and minimize claim rejections.
At InvicieQ, we specialize in streamlining your revenue cycle and reducing medical billing denials. Whether it’s coding support, claim management, or full-service RCM, our experts can help. Contact us today to learn more.