MID-CYCLE
Clinical Denial Management Services
Identify coding issues, educate clinicians, and prevent denials before they cost you revenue.
10%+
Claims denied even in well-run departments
65%
Denied claims never resubmitted
50%+
Cost savings via offshore delivery
Clinical Denial Management Services
Coding denials are a significant component of claim denials. While the most cost-effective mechanism for recovering revenue is ensuring optimal payments are received the first time a claim is submitted, more than 10% of claims are denied even for well-run revenue cycle departments.
Why Denials Go Unaddressed
Due to the intense resource requirements for appealing denied claims, providers do not resubmit or appeal as many as 65% of denied claims. Lack of staff and lack of certified medical coders are the most common reasons cited.
Our Approach to Denial Management
We bring efficient processing, denial management expertise, and an offshore price structure to deliver a cost-effective solution — combined with training programs and structured procedures for addressing each denial code.
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Root-Cause Denial Analysis: Retrieving medical records, reviewing codes, and assessing clinical documentation to identify what caused the denial.
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Certified Coding Expertise: Specialty-experienced certified coders apply the right codes and modifiers per AMA guidelines and CCI edits.
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Efficient Re-coding & Resubmission: Performing coding edits in line with payer-specific guidelines before resubmitting the claim.
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Structured Denial Prevention Training: Training programs for denial management personnel and structured policies for each denial code.
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Ongoing Monitoring & Reporting: Tracking denial trends to shift focus from reactive management to proactive prevention.
WHAT CLIENTS SAY
Trusted by Practices Across the Country
Practices that partner with our Clinical Denial Management team see fewer coding-related denials, faster resubmissions, and stronger revenue recovery.
★★★★★
“I want to take a moment to thank Medical Billing Wholesalers for their extra hard work and commitment in reducing our Missing Slip inventory. The combined efforts of Offshore and our TVH Team had our Missing Slip Inventory down from 22K to 13K.”
— A Florida-Based Healthcare Center
Benefits of Our Clinical Denial Management Services
Significant Cost Savings: Over 50% cost savings by leveraging our offshore operations, without compromising on quality.
Improved Claim Accuracy & Compliance: Enhances the accuracy of clinical documentation and claims to meet stringent regulations.
Proactive Denial Prevention: We aim to not just manage denials, but prevent them by identifying root causes.
Enhanced Revenue Recovery: Meticulous analysis and appeals improve the likelihood of successful reimbursement.
Data-Driven Insights: Data analytics reveal denial patterns and trends, informing continuous improvement.
Focus on Patient Care: Managing clinical denials frees your healthcare professionals to focus on patient care.
PROVEN DENIAL MANAGEMENT OUTCOMES
Real Results From Mid-Cycle Clients
Get Our Latest Thinking
FREE CLINICAL DENIAL REVIEW
See which clinical denials you can still win
We look at your denials, A/R and collections, including medical necessity, level-of-care and coding denials, then show you what is achievable, with no obligation to switch.
What you’ll get
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A review of your clinical denial trends and their root causes
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A look at open denials with appeal deadlines still ahead
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An estimate of revenue leaking from your current process
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A written improvement plan you keep, whether or not you work with us
SOC 2 Type II · HIPAA compliant · ISO 27001 certified
Get a Custom Quote
Share a few details about your needs and we will send a custom quote based on your claim volume, payer mix and the services you need.
No-obligation consultation
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Reply from an RCM specialist
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