Denial Management
Over Half of Denied Claims Are Never Refiled. Ours Are.
The industry average is damning — more than 50% of denials die in a queue somewhere. At KeyMed, every denial gets reviewed, categorized, root-caused, and either appealed or prevented from happening again. We don't close a claim until every option is exhausted, because denied claims represent up to 3% of your net revenue — money that was earned, documented, and billed correctly but still didn't get paid.
Denials Are a Revenue Problem, Not a Paperwork Problem
The average denial rate hit 11.8% in 2024, and it's still climbing. Payers are more aggressive with prior auth requirements, medical necessity reviews, and clinical documentation requests. For a $5 million practice, denied claims can mean $150,000 a year sitting unrecovered. Every unworked denial has a double cost — the staff time you invested and the revenue you'll never see. The practices that recover that money aren't the ones with bigger billing departments. They're the ones with a structured denial management process, dedicated people, and the stubbornness to fight every appeal to the end.
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.
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.
30-50%
Denial Reduction
Clients consistently see significant drops within the first 90-120 days.
52 → 31
Days in AR
~40% reduction — top-quartile against an industry average of 45-50 days and worsening.
84%
Collection Rate on AR >90 Days
Because denied claims don't stay denied when someone actually works them.
3%
Of Net Revenue at Risk from Denials
HFMA research, across provider types and sizes.