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Take Control of Claim Denials with MedVerix RCM
Denied claims don’t have to slow you down. At MedVerix RCM, our Denial Management Services are designed to pinpoint issues, fix them fast, and keep your revenue flowing. With a proactive, data-driven approach, we reduce rejections and recover payments efficiently—so you can focus on delivering care while we protect your bottom line.
What Is Denial Management?
Denial management is a critical component of revenue cycle success—and it’s more than just fixing errors. At MedVerix RCM, we understand that denied and rejected claims each require a tailored strategy. While rejected claims are those that never reach the payer's adjudication system due to errors and must be corrected and resubmitted, denied claims are processed but refused for payment, often due to deeper issues like Authorization problems or AOB (Assignment of Benefits) discrepancies. To recover revenue efficiently, healthcare providers need to address both. Rejected claims can be fixed quickly, but denied claims require root-cause analysis, detailed follow-ups, and sometimes formal appeals—all of which demand time, expertise, and precision.
Key Phases of Denial Management Services
We take a strategic and proactive approach to denial management, helping healthcare providers protect their revenue, reduce delays, and improve overall financial performance. Our denial management services are built on a thorough process that identifies, resolves, and prevents claim denials with precision and speed. Here's how we do it:
The first step in our denial management process is to accurately identify denied claims and the specific reasons behind them. Leveraging our integrated payment posting and analytics tools, we categorize denials—whether due to coding errors, missing authorizations, or data mismatches—and prepare them for deeper analysis. This phase ensures that no denial goes unnoticed and sets the stage for corrective action.
MedVerix RCM doesn’t just correct denials—we investigate them. Our expert team digs into the underlying causes, whether it's incorrect billing, incomplete documentation, or payer-specific rule violations. We address both individual claim errors and systemic issues, using our findings to develop lasting solutions that prevent repeat denials and strengthen front-end processes.
Once root causes are established, our team prepares robust, accurate appeals tailored to each payer's unique guidelines. We gather supporting documents such as medical records, coding updates, and patient information, working closely with your internal teams to ensure everything aligns. Each appeal is meticulously crafted to defend the claim and increase the likelihood of reimbursement.
Timing is critical. MedVerix RCM ensures all appeals are submitted promptly and in full compliance with payer requirements. We monitor deadlines, track submissions, and maintain clear communication with payers throughout the process. By managing each step with precision, we significantly improve your chances of a successful claim reversal and faster reimbursement.
Beyond appeal resolution, we implement a continuous improvement model. We analyze trends, identify high-risk claim types, and provide ongoing recommendations to enhance your billing and coding practices. Through staff training, workflow optimization, and system upgrades, MedVerix RCM helps you build a resilient revenue cycle that reduces future denials and boosts financial performance.
What Are the Most Common Denials in Medical Billing?
In medical billing, denials can disrupt revenue flow and increase administrative burden. At MedVerix RCM, we frequently encounter the following common denial reasons:
Claims may be denied if basic information like name, date of birth, or insurance ID is incorrect or missing.
Submitting claims for patients who are not eligible for coverage on the date of service is one of the top reasons for denials.
Many insurance plans require prior authorization for specific procedures. Failing to obtain it leads to automatic denials.
Claims submitted more than once for the same service can be rejected as duplicates, even if intended to correct errors.
Coding errors, including outdated or mismatched procedure/diagnosis codes, result in denied claims.
If a service isn’t included in a patient’s plan or isn’t deemed medically necessary, the claim will be denied.
Each payer has a strict deadline for submitting claims. Missing that window leads to non-payment.
When a patient has more than one insurance policy, failure to confirm the primary payer can delay or deny payment.
Understanding these common denials helps your team proactively prevent them. MedVerix RCM combines smart systems and experienced denial management experts to identify root causes and resolve them quickly—protecting your cash flow and improving claim success rates.
Our Denial Management Solutions
Claim Resolution Focus
We don’t just report on claim issues — we fix them. Our team is dedicated to identifying the root causes of denials and taking immediate action to ensure successful, timely resolutions.
Claim Status Checking
By leveraging web portals and electronic access, we reduce the manual effort required for claim follow-up. Our automated tools streamline the status-checking process, giving your team more time to focus on high-impact tasks.
Workflow Automation
We utilize intelligent, web-based workflows customized for each claim status code. These systems guide payers through relevant questions and documentation steps, helping resolve denials faster and with greater accuracy.
Comprehensive Dashboards
Our data-driven dashboards and multi-variable reports provide in-depth insights into your accounts receivable (A/R). This enables proactive decision-making and prioritization of critical issues that impact your bottom line.
A/R Reduction
Our clients benefit from a minimum 20% reduction in A/R days and a 5–7% increase in collections. By streamlining denial recovery and claim resolution, we help improve cash flow and financial stability.
Regulatory Compliance
Stay ahead of changing healthcare regulations. Our denial management experts ensure full compliance with payer requirements and coding standards, reducing the risk of audit failures or compliance penalties.