Top 5 Reasons for Clinical Denials and How to Address Them

Clinical denials drain billions from healthcare each year, often due to preventable errors. From lack of medical necessity to documentation gaps and authorization issues, small mistakes cause major revenue loss. This guide highlights the top five denial reasons and proven strategies providers can use to prevent denials and protect financial health.

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How Automating Patient Eligibility Reduces Front-End Denials and Speeds Up Claim Approvals

Front-end claim denials drain revenue and slow down reimbursements. This guide explains how automating patient eligibility checks can prevent errors, improve claim success rates, and streamline your healthcare billing process.

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What You Need to Know About OBGYN Medical Billing

OBGYN medical billing is complex, involving global maternity billing, multiple CPT codes, compliance requirements, and payer-specific rules. Errors lead to denials and lost revenue. By streamlining workflows, verifying insurance upfront, and leveraging specialized billing services, practices can reduce rework, improve cash flow, and ensure compliance for long-term financial health.

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The Top 5 Reasons Your Claims Are Being Underpaid (and How to Fix Them)

Underpaid claims drain healthcare revenue. From coding errors to payer mismatches, small mistakes cost providers thousands. Learn the top 5 causes of underpayment—and proven strategies to recover revenue and strengthen your revenue cycle.

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How Medical Practices Can Improve Accounts Receivable Management Services?

Handling accounts receivable properly helps medical practices avoid delayed payments and claim issues. Explore five simple methods to ensure timely reimbursements, improve patient payment rates, and strengthen revenue tracking.

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Case Study: Physician Education helps resolve BMI Diagnosis Claim Denials of over $37 K

Many Primary Care Physicians lose money because of lack of understanding of payer specific claims submission guidelines. Educating physicians on their documentation responsibilities is an iterative process, that requires an understanding of the reasons for claim denials, ability to nail-down the issues that are causing the denials, determining the corrective actions, and hosting timely sessions between the denials team and the physicians to discuss them.

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Case Study: Correct Coding and Electronic Submission of Podiatry Claims reduce denials by 23% and improves collection by 25%

Bad quality scanning of superbills and lack of adoption of electronic claims submission creates a charge backlog situation and consequently, result in increased denials on account to timely filing dates not being adhered to. Read this case study about how our structured approach, technical expertise, and revenue cycle rigor combine to create value for our client.

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Case Study: Improved Revenue Cycle Workflow and reporting functionality accelerates Cash Flow

Most revenue cycle systems have a wealth of unutilized functionality. Revenue cycle professionals need to evaluate workflow and reporting functionality on the revenue cycle system to not only ease their workload but also improve revenue cycle outcomes. Read more in this case study.

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Case Study: Addressing Notice of Levy issues to Improve Reimbursements

Notice of Levy issues may be wrongly construed to be claim denials if a thorough investigation is not done to understand the reason behind such cases. Further, it is imperative that physicians pay their taxes on time. By educating physicians/practice teams on the importance of filing taxes, an artificial surge in denials on account of notice of levy cases can be avoided.

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Shifting the Focus from Denial Management to Denial Prevention

The adage, “Prevention is better than cure”, does apply to Claim Denials as well. An effective denial prevention program requires an iterative process that includes identification of root cause, finding solutions to prevent the issue from recurring in the future, the institutionalization of these procedures through updates to standard operating procedures, and training the staff on these practices. In this whitepaper from Medical Billing Wholesalers, we bring you a few steps that you can take to prevent denials.

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