Denial Management
Over Half of Denied Claims Are Never Refiled. Ours Are.
Real denial management is denial prevention first: our specialists scrub claims against payer edits before they go out, then root-cause and appeal the denials that remain. That is how you protect the revenue that denials quietly drain away.
Denials Are a Revenue Problem, Not a Paperwork Problem
Denials quietly drain earned revenue, and the practices that recover it have a structured process and dedicated people, not just a bigger billing department.
Over Half Never Refiled
Industry-wide, over 50% of denials are never refiled. Every unworked denial costs twice: the staff time you invested and the revenue you never see.
Write-Offs Above 3% Are a Red Flag
HFMA benchmarks flag avoidable write-offs above roughly 3% of expected collections as a warning sign: money earned, documented, and billed correctly that still didn't get paid.
A 50% Denial Reduction
A structured denial management process, with technology that prevents denials and a named team that appeals the rest, drives a 50% reduction in your denial rate.
Predictive Denial Prevention
The cheapest denial to work is the one you never receive, so we track first-pass acceptance, not just appeals won. The edit-rule scrubbing that stops a wrong claim from going out belongs to Claim Submission & Scrubbing, and it works hand-in-hand with our Eligibility & Benefit Verification and Medical Coding so the denial never gets created in the first place.
Root Cause Identification and Prevention
We don't just appeal denials. We categorize them by type, payer, provider, and reason code to identify the patterns costing you the most money. Fix the root cause, feed the insight back to your coding and intake workflows, and the denial stops repeating.
Structured Appeal Workflow
Every appealable denial follows a documented process: research, clinical documentation, payer-specific appeal strategy, submission, and tracking through resolution. Our team knows which payers respond to which approaches, because generic appeal letters don't win.
Multi-Level Escalation
First-level appeals are just the beginning. Our team pursues second and third-level appeals, external reviews, and payer supervisor escalation when the claim warrants it. Payers that delay get called, not waited on. It is the same persistence we bring to Insurance A/R Follow-Up on claims that stall without ever being denied.
Financial Impact Reporting
Monthly denial reports break down every denial by payer, reason, status, and dollar value. You see exactly where you're losing money, what we recovered, and what we prevented: actual dollars, not activity metrics.
50%
Denial Reduction
Measured against your current denial rate, within the first 90-120 days, reviewed quarterly.
52 to 31
Days in AR
~40% reduction, top-quartile against an industry average of roughly 45-50 days (MGMA/HFMA) and worsening.
84%
Collection on AR >90 Days (documented case)
One documented engagement: 375 accounts averaging 224 days old, because denied claims don't stay denied when someone actually works them.
3%
The Write-Off Red-Flag Threshold
HFMA benchmarks flag avoidable write-offs above roughly 3% of expected collections.
The 84% is a documented client result; the 50% denial reduction and the move to 31 days in AR are measured against your own baseline. See how we measure
Denial Management & Prevention FAQs
How does KeyMed reduce denials?
KeyMed prevents denials before submission and works the rest to resolution. Claims are scrubbed against payer-specific edit rules by our Claim Submission & Scrubbing service before they go out, and a named team root-causes, appeals, and escalates the denials that remain. Clients see a 50% reduction in denials within the first 90-120 days, measured against their starting denial rate and reviewed quarterly.
Does KeyMed just appeal denials, or prevent them?
Both. The best denial is the one that never happens, which is what our Claim Submission & Scrubbing service is for. When a denial does occur, every appealable claim follows a documented process (research, clinical documentation, payer-specific strategy, submission, and tracking through resolution) including second- and third-level appeals and external review when warranted.
What is a typical denial rate, and what do denials cost?
The average denial rate reached 11.8% in 2024 and continues to climb. HFMA benchmarks flag avoidable write-offs above roughly 3% of expected collections as a red flag, and more than half of denials are never refiled. For a $5 million practice, that threshold alone represents about $150,000 a year.
How quickly will we see results?
Most clients see measurable denial reduction within the first 90-120 days. Results are documented in quarterly reviews that break down every denial by payer, reason, status, and dollar value: actual dollars recovered and prevented, not activity metrics.